NICE issues guidance on newer anti-epilepsy drugs
Guidance on the use of newer drugs for epilepsy in adults has been issued by the National Institute for Clinical Excellence.
The guidance states that prescriptions for newer anti-epilepsy drugs
have been increasing as a proportion of the total spend. According to
recent analysis they account for 20 per cent of total items and 69 per
cent of total costs (£99m of £142m in 2002).
Newer drugs
· Gabapentin (Neurontin)
· Lamotrigine (Lamictal)
· Levetiracetam (Keppra)
· Oxcarbazepine (Trileptal)
· Tiagabine (Gabitril)
· Topiramate (Topamax)
· Vigabatrin (Sabril) |
NICE recommends that the newer drugs (see Panel) should be used in the
management of adults with epilepsy who have not benefited from treatment
with older agents such as carbamazepine or sodium valproate. Newer agents
should also be used where older drugs are unsuitable, for example because
of contraindications, interactions with other drugs, poor tolerance,
or where the patient is a woman of childbearing age.
The guidance further recommends the following:
· Treatment should be with monotherapy wherever possible
· Combination therapy should only be considered when attempts at monotherapy
have not resulted in freedom from seizures
· In women of childbearing age, the possibility of interaction with oral
contraceptives and the risk of the drugs causing harm to an unborn child
should be discussed and an assessment made as to the risks and benefits
of treatments with individual drugs. Specific caution is advised in the
use of sodium valproate because of the risks to an unborn child
· All people having a first seizure should be seen as soon as possible
by a specialist in epilepsy management to ensure prompt and early diagnosis
and initiation of appropriate therapy
· Treatment should be reviewed at regular intervals
Commenting on the new guidance, Charles Tugwell, clinical pharmacist
neurology/neurosurgery, Royal London Hospital, says: “NICE does
little more than reinforce what should be happening in clinical practice
anyway.”
He adds that clinical guidelines on the diagnosis, management and drug
treatment of epilepsy are due to be published by NICE later this year. “Detailed
guidance on monitoring, optimising and reviewing therapy is needed. Since
NICE acknowledges that drug therapy is the mainstay of management of
people with epilepsy, it is hoped that the roles pharmacists should play
will be referred to in the new document.”
NICE says that this guidance is expected to have a neutral impact on
prescribing trends. However, there will be implications for provision
of specialist services in order for new patients to be seen quickly and
reviewed regularly.
NICE also reports that the NHS R&D health technology assessment programme
has sponsored a large randomised trial of longer term outcomes and cost
effectiveness of standard versus new anti-epileptics. The study hopes
to recruit around 3,000 UK patients over three years. It intends to provide
robust evidence for the efficacy of the newer anti-epilepsy drugs (www.nice.org.uk).
Palliative care Advice on how to ensure cancer patients, their
families and carers are well informed, cared for and supported is
outlined in NICE guidance published this week. Key recommendations
are that all health care professionals involved in care inform each
other about developments affecting the patient and provide co-ordinated
care. A specific problem in the delivery of care identified by the
report was inadequate access to pharmacy services outside normal
working hours. The guidance is available via the NICE website
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