TY - JOUR

T1 - Therapeutic drug monitoring of newer generation antiseizure medications at the point of treatment failure

AU - Fluckiger, Paul

AU - Aícua-Rapún, Irene

AU - André, Pascal

AU - Rossetti, Andrea O.

AU - Decosterd, Laurent A.

AU - Buclin, Thierry

AU - Novy, Jan

N1 - Publisher Copyright: © 2021 The Author(s)

PY - 2022

Y1 - 2022

N2 - Purpose: The benefit of therapeutic drug monitoring (TDM) of newer generation antiseizure medications (ASM) has been little studied. A recent randomized study suggested that TDM at each medical visit did not bring a significant benefit, but the study did not investigate TDM in cases of treatment failure. Accordingly, we realized a post hoc analysis of this trial. Methods: We analyzed 282 TDMs in 136 patients. We compared TDM performed at visits after treatment failure versus without treatment failure, reporting the proportion of drug levels out of range and the prescriber's adherence to dosage recommendations according to measured drug levels. Results: There was no statistical difference in terms of proportion of out of range plasma drug levels (47% vs 50%, p = 0.7) or adherence of prescribers to the clinical pharmacologists’ dosage recommendations (21% vs 30%, p = 0.6) between visits after treatment failure and visits without treatment failure, respectively. Knowledge of prior drug levels did not modify the results. Conclusion: Systematic TDM at appointments following treatment failure showed similar results to TDM at visits without treatment failure. The prescribers’ adherence with dosage recommendations was low in both cases. It is not clear whether better prescriber adherence would improve patient outcome. Furthermore, the ability to detect poor patient compliance is limited in a planned outpatient appointment. The study setting does not reflect on the general usefulness of TDM.

AB - Purpose: The benefit of therapeutic drug monitoring (TDM) of newer generation antiseizure medications (ASM) has been little studied. A recent randomized study suggested that TDM at each medical visit did not bring a significant benefit, but the study did not investigate TDM in cases of treatment failure. Accordingly, we realized a post hoc analysis of this trial. Methods: We analyzed 282 TDMs in 136 patients. We compared TDM performed at visits after treatment failure versus without treatment failure, reporting the proportion of drug levels out of range and the prescriber's adherence to dosage recommendations according to measured drug levels. Results: There was no statistical difference in terms of proportion of out of range plasma drug levels (47% vs 50%, p = 0.7) or adherence of prescribers to the clinical pharmacologists’ dosage recommendations (21% vs 30%, p = 0.6) between visits after treatment failure and visits without treatment failure, respectively. Knowledge of prior drug levels did not modify the results. Conclusion: Systematic TDM at appointments following treatment failure showed similar results to TDM at visits without treatment failure. The prescribers’ adherence with dosage recommendations was low in both cases. It is not clear whether better prescriber adherence would improve patient outcome. Furthermore, the ability to detect poor patient compliance is limited in a planned outpatient appointment. The study setting does not reflect on the general usefulness of TDM.

KW - Antiepileptic drugs

KW - Antiseizure drugs

U2 - 10.1016/j.seizure.2021.11.022

DO - 10.1016/j.seizure.2021.11.022

M3 - Journal article

C2 - 34864254

AN - SCOPUS:85120479481

VL - 94

SP - 66

EP - 69

JO - Seizure : the journal of the British Epilepsy Association

JF - Seizure : the journal of the British Epilepsy Association

SN - 1059-1311

ER -