Assessment of Antiepileptic Drug Concentrations in HIV-Infected versus HIV-Negative Patients: A Retrospective Analysis
- 17 Downloads
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.
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.
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).
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.
This study was carried out as part of our routine work, and no external funds were used.
Compliance with Ethical Standards
Conflicts of interest
Cristina Gervasoni and Massimo Galli have received educational grants from Merck Sharp & Dohme (MSD), Janssen-Cilag, Bristol Myers Squibb, Boehringer Ingelheim, ViiV Healthcare and Abbvie. Paola Meraviglia has received educational grants from Merck Sharp & Dohme (MSD), Janssen-Cilag, Bristol Myers Squibb, Boehringer Ingelheim and ViiV Healthcare. Dario Cattaneo has received educational and travel grants from Merck Sharp & Dohme (MSD) and ViiV Healthcare. Sara Baldelli, Andrea Giacomelli, Davide Minisci, Noemi Astuti, Marta Fusi, Valeria Cozzi, and Emilio Clementi declare that they have no potential conflicts of interest that might be relevant to the contents of this manuscript.
- 2.Zaccara G, Perucca E. Interactions between antiepileptic drugs, and between antiepileptic drugs and other drugs. Epileptic Disord. 2014;16:409–31.Google Scholar
- 5.Birbeck GL, French JA, Perucca E, Simpson DM, Fraimow H, George JM, Quality Standards Subcommittee of the American Academy Of Neurology, Ad Hoc Task Force of the Commission on Therapeutic Strategies of the International League Against Epilepsy, et al. Antiepileptic drug selection for people with HIV/AIDS: evidence-based guidelines from the ILAE and AAN. Epilepsia. 2012;53:207–14.CrossRefGoogle Scholar
- 6.Sarma AK, Khandker N, Kurczewski L, Brophy GM. Medical management of epileptic seizures: challenges and solutions. Neuropsychiatr Dis Treat. 2016;12:467–85.Google Scholar
- 7.Kirmani BF, Mungall-Robinson D. Role of anticonvulsants in the management of AIDS related seizures. Front Neurol. 2014;5:10.Google Scholar
- 11.Cattaneo D, Baldelli S, Resnati C, Giacomelli A, Meraviglia P, Minisci D, et al. Evaluation of the concentrations of psychotropic drugs in HIV-infected versus HIV-negative patients: potential implications for clinical practice. World J Biol Psychiatry. 2018. https://doi.org/10.1080/15622975.2018.1500032 (Epub 20 Sep 2018).Google Scholar
- 14.Landmark CJ, Johannessen SI, Tomson T. Dosing strategies for antiepileptic drugs: from a standard dose for all to individualised treatment by implementation of therapeutic drug monitoring. Epileptic Disord. 2016;18:367–83.Google Scholar