Dario Cattaneo1,2, Sara Baldelli2, Andrea Giacomelli3, Davide Minisci3, Paola Meraviglia3, Noemi Astuti3, Marta Fusi2, Valeria Cozzi2, Emilio Clementi4,5, Massimo Galli3, Cristina Gervasoni6,7,8. 1. Gestione Ambulatoriale Politerapie (GAP) Outpatient Clinic, ASST Fatebenefratelli Sacco, Milan, Italy. 2. Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco, Milan, Italy. 3. Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy. 4. Clinical Pharmacology Unit, Department of Biomedical and Clinical Sciences, Consiglio Nazionale delle Ricerche Institute of Neuroscience, Sacco University Hospital, Università degli Studi di Milano, Milan, Italy. 5. E. Medea Scientific Institute, Bosisio Parini, Italy. 6. Gestione Ambulatoriale Politerapie (GAP) Outpatient Clinic, ASST Fatebenefratelli Sacco, Milan, Italy. cristina.gervasoni@unimi.it. 7. Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy. cristina.gervasoni@unimi.it. 8. Department of Infectious Diseases, Luigi Sacco University Hospital, Via GB Grassi 74, 20157, Milan, Italy. cristina.gervasoni@unimi.it.
Abstract
INTRODUCTION: A higher rate of subtherapeutic psychotropic drug concentrations was recently found in HIV-infected versus HIV-negative patients. In this study, we sought to investigate if this trend could also apply to antiepileptic drugs. METHODS: Overall, 700 HIV-infected patients were screened during the first 2 years after the introduction of our outpatient polytherapy management service (Gestione Ambulatoriale Politerapie [GAP]) in the search for subjects with antiepileptic drug trough concentration assessments. The distribution of such concentrations was compared with that in HIV-negative patients monitored over the same period. RESULTS: The search identified 97 HIV-infected patients concomitantly receiving antiretroviral and antiepileptic drugs, for a total of 310 drug measurements. Overall, 30%, 64% and 6%, versus 28%, 65% and 7%, of the antiepileptic concentrations measured in HIV-infected versus HIV-negative patients (1090 patients, for a total of 3488 antiepileptic concentrations measured) were below, within, or above the therapeutic targets, respectively. The antiepileptic drug valproate was associated with the highest risk of subtherapeutic drug concentrations, with 57% and 46% of determinations below the therapeutic range in HIV-positive and HIV-negative patients, respectively. Remarkably, the concentrations of valproate were significantly lower in HIV-infected versus HIV-negative patients (47.9 ± 21.2 versus 53.9 ± 21.6 mg/L; p < 0.05). CONCLUSION: In our retrospective study, most HIV-infected patients had antiepileptic drug concentrations falling within the therapeutic targets, with the exception of valproate, which was associated with a higher rate of subtherapeutic concentrations compared with other antiepileptic drugs.
INTRODUCTION: A higher rate of subtherapeutic psychotropic drug concentrations was recently found in HIV-infected versus HIV-negative patients. In this study, we sought to investigate if this trend could also apply to antiepileptic drugs. METHODS: Overall, 700 HIV-infectedpatients were screened during the first 2 years after the introduction of our outpatient polytherapy management service (Gestione Ambulatoriale Politerapie [GAP]) in the search for subjects with antiepileptic drug trough concentration assessments. The distribution of such concentrations was compared with that in HIV-negative patients monitored over the same period. RESULTS: The search identified 97 HIV-infectedpatients concomitantly receiving antiretroviral and antiepileptic drugs, for a total of 310 drug measurements. Overall, 30%, 64% and 6%, versus 28%, 65% and 7%, of the antiepileptic concentrations measured in HIV-infected versus HIV-negative patients (1090 patients, for a total of 3488 antiepileptic concentrations measured) were below, within, or above the therapeutic targets, respectively. The antiepileptic drug valproate was associated with the highest risk of subtherapeutic drug concentrations, with 57% and 46% of determinations below the therapeutic range in HIV-positive and HIV-negative patients, respectively. Remarkably, the concentrations of valproate were significantly lower in HIV-infected versus HIV-negative patients (47.9 ± 21.2 versus 53.9 ± 21.6 mg/L; p < 0.05). CONCLUSION: In our retrospective study, most HIV-infectedpatients had antiepileptic drug concentrations falling within the therapeutic targets, with the exception of valproate, which was associated with a higher rate of subtherapeutic concentrations compared with other antiepileptic drugs.
Authors: Lisbeth Patteet; Manuel Morrens; Kristof E Maudens; Peter Niemegeers; Bernard Sabbe; Hugo Neels Journal: Ther Drug Monit Date: 2012-12 Impact factor: 3.681
Authors: Srđan Stefanović; Slobodan M Janković; Milan Novaković; Marko Milosavljević; Marko Folić Journal: Expert Opin Drug Metab Toxicol Date: 2017-12-26 Impact factor: 4.481
Authors: Gretchen L Birbeck; Jacqueline A French; Emilio Perucca; David M Simpson; Henry Fraimow; Jomy M George; Jason F Okulicz; David B Clifford; Houda Hachad; René H Levy Journal: Epilepsia Date: 2012-01 Impact factor: 5.864