NNA Nik Othseman1, KK Lim1, CMY Sam1, N Abdul Rahman1, LM Lian1, S Sivasampu1, SF Abu2 1 Clinical Research Centre, National Institute of Health
INTRODUCTION
Epilepsy is one of the most prevalent neurological disorders with over 50 million sufferers in the world among which 85% live in developing countries and at least 50% of cases begin at childhood or adolescence (1). Therefore long term pharmacological control plays a key role in epilepsy treatment. A Malaysian guideline on epilepsy management was released in 2005 (2) and was further updated in 2010 (3) to guide prescribing of anti-epileptic drugs (AEDs). However, there has been no quality indicator of AEDs utilisation in the country.
2. Pharmaceutical Services Division, Ministry of Health
RESULTS Result 1 : DU 90% of Anti-Epileptics Drugs in Public Sector for Year 2006 and 2007
OBJECTIVE
To compare the DU90% profiles anti-epileptic drugs in public and private sectors Malaysia in year 2006 and 2007.
METHODOLOGY
Data from National Medicine Use Survey (NMUS) database were used. Drugs were coded according to ATC/DDD system and its utilisation expressed as DDD/1000population/day.4 The AEDs were ranked according to volume of DDDs and drugs that accounted for 90% of the total utilisation volume, i.e. the DU90% were identified. Drugs found within the DU90% segments were classified as either old- or new-generation AEDs. Result 2 : DU 90% of Anti-Epileptics Drugs in Private Sector for Year 2006 and 2007
DISCUSSION
Overall AEDs utilisation (in terms of DDD/1000 pop / day) was much higher in public sector (1.35 vs 0.16 in 2006 and 1.38 vs 0.26 in 2007). A total of 12 – 14 AEDs were used, with 4 – 6 different drugs within the DU90% segments in each sector for each year. Old-generation AEDs occupied the bulk of the DU90% segments in 2006 (public 91%, private 74%), in line with the 2005 guideline which recommended old-generation AEDs as first choice therapy for most seizure types (2). Phenytoin which was a second-choice drug in the guideline, was consistently the most used AED (≈30%) except in private sector in 2007 where valproic acid was favoured. This could be attributed to its cheap price and its long history of existence which leads to familiarity by the clinicians (5). Proportion of old-generation AEDs utilisation declined slightly in 2007 (public 87%, private 59%), with increasing use of new-generation AEDs. New-generation AEDs are reported to have equivalent efficacies and better side effect profiles compared to the older-generation drugs (6,7) and this trend indicates a growing awareness among the prescribers. Lamotrigine (≈4%) was the only new-generation AED found within the DU90% segment of public sector in 2007. The Malaysian guideline in 2005 recommended it as monotherapy in absence seizures and as adjuncts in several types of seizures(2). Some clinical evidences showed lamotrigine was efficacious as monotherapy in newly diagnosed partial and tonic-clonic seizures and in some cases greater efficacy over standard AEDs such as carbamazepine. (6,7). Private sector observed a tremendous growth in utilisation of both gabapentin and levetiracetam in 2007. While clinical evidences showed the efficacy of gabapentin as the initial monotherapy, there is insufficient evidence to support such use of levetiracetam (6,7). Both drugs are recommended as adjuncts in the 2005 guideline (2), indicating probably higher usage of adjuncts in anti-epilepsy management or inappropriate use as first-line drugs in the private sector. Also as our data collection did not differentiate utilisation according to indications, the gabapentin figures may include usage for neuralgia.
Older Anti-epileptic Drugs
New Anti-epileptic Drugs
CONCLUSION
The DU90% methodology is a useful method in assessing the pattern and general quality of AED utilisation in Malaysia
REFERENCES 1.
2. 3. 4. 5. 6.
7.
WHO Mental Health retrieved from http://www.who.int/mental_health/neurology/epilepsy/en/index.html Consensus Guideline Management of Epilepsy 2005 WHO ATC / DDD Methodology fromhttp://www.whocc.no/atc_ddd_methodology/purpose_of_the_atc_ddd_system/ Chapter 49: Pharmacogenetics of Antiepilecitc Medications. page 779. Wyllie’s Treatment of Epilepsy: Principles and Practice By Elaine Wyllie, Gregory D. Cascino, Barry E. Gidal ILAE Treatment Guidelines: Evidence-based Analysis of Antiepileptic Drug Efficacy and Effectiveness as Initial Monotherapy for Epileptic Seizures and Syndromes Efficacy and tolerability of the new antiepileptic drugs : Treatment of new onset epilepsy : Report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society Epilepsy Council, Malaysian Society of Neurosciences. Malaysian Consensus Guidelines on the Management of Epilepsy 2010
*We would like to thank Director General of Health, Malaysia for permission to publish this poster
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