Rise in prescribing of newer antiepileptics
Prescribing of newer antiepilepsy drugs for children has increased five-fold since 1993, an analysis of the UK General Practice Research Database suggests (British
Journal of Clinical Pharmacology 2007;63:689). However, the authors of the study say that the long-term safety of these drugs has yet to be established.
In 1993 antiepilepsy drugs were prescribed for under-18s at a prevalence
of 7.3 per 1,000 person years. By 2005 this had increased by 19 per cent
to 8.7 per 1,000 person years, according to the analysis.
Prescribing of older antiepilepsy medicines actually fell — the
overall rise was accounted for by a five-fold increase in the prescribing
of newer antiepilepsy drugs, in particular lamotrigine, topiramate and
levetiracetam.
Commenting on this finding, Ian Wong, professor of paediatric research
and director of the centre for paediatric pharmacy research at the School
of Pharmacy, London, and one of the study authors, said: “The uptake
of these drugs has been rapid, yet their long-term safety has not been
established and further research must now be seen as a priority.” He
added: “These newer antiepilepsy drugs are subject to fewer licensing
restrictions because there is more evidence about their benefits, gathered
from clinical trials, than their more traditional counterparts. As new
safety data emerge, restrictions in prescribing may be implemented.”
The analysis, which included 7,721 subjects prescribed at least one antiepilepsy
drug, suggests that National Institute for Health and Clinical Excellence
guidance is being implemented, since 70 per cent of patients were prescribed
just one drug. NICE recommends that children with epilepsy should be
treated with monotherapy wherever possible.
The authors of the paper recommend that long-term safety surveillance
of all the newer antiepilepsy drugs should be a priority for future study
and, as a result of this research, Professor Wong has been awarded a
research contract by the Medicines and Healthcare products Regulatory
Agency to assess deaths among children and adolescents taking antiepilepsy
drugs.
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