Role of clinical pharmacists in epilepsy management at a general hospital in Vietnam: a before-and-after study

Hong Tham Pham, Minh-Hoang Tran, Ngoc Quy Nguyen, Van Tan Vo, Manh Hung Tran, Hong Tham Pham, Minh-Hoang Tran, Ngoc Quy Nguyen, Van Tan Vo, Manh Hung Tran

Abstract

Background: Clinical pharmacists have an important role in inter-professional healthcare collaboration for epilepsy management. However, the pharmacy practices of managing epilepsy are still limited in Vietnam, deterring pharmacists from routine adjustments of antiepileptic drugs, which could decrease the patients' quality of life. This study aimed to assess the effectiveness of pharmacist interventions in epilepsy treatment at a Vietnamese general hospital.

Methods: A before-and-after study was conducted from January 2016 to December 2018. All patients with a diagnosis of epilepsy and being treated at the investigated hospital were recruited and screened for eligibility and exclusion criteria. The primary outcome was the proportion of patients in good control of their epilepsy (with two seizures or less in a year). The secondary outcome was the number of patients maintaining optimized concentrations within the therapeutic range of carbamazepine (4-12 mg/L), phenytoin (10-20 mg/L), or valproic acid (50-100 mg/L). Collected data were analyzed using two proportions Z-test or Chi-square test.

Results: A total of 141 participants were enrolled in the study. While most patients were given lower prescribed daily doses than the recommendations from the World Health Organization, over 56% of the participants still experienced adverse drug effects. More than half of the patients received at least one pharmacists' intervention, which increased by 25.0% the effectiveness of the therapy (p < 0.001) and by 14.6% the number of patients with optimized drug concentrations (p = 0.018).

Conclusion: Epilepsy management requires a multiple-stepped and comprehensive approach, with a focus on the health and safety of the patients. As part of the healthcare team, pharmacists need to engage at every stage to monitor the patient's response and determine the most effective treatment with the fewest adverse drug reactions. Trial registration ClinicalTrials.gov, NCT04967326. Registered July 19, 2021-Retrospectively registered, https://ichgcp.net/clinical-trials-registry/NCT04967326.

Keywords: Adverse drug reaction; Antiepileptic drug; Clinical pharmacist; Epilepsy; Vietnam.

Conflict of interest statement

The authors declare that they have no competing interests relevant to the study.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flow diagram of the study participants

References

    1. Fiest KM, Sauro KM, Wiebe S, Patten SB, Kwon C-S, Dykeman J, et al. Prevalence and incidence of epilepsy: a systematic review and meta-analysis of international studies. Neurology. 2017;88(3):296–303. doi: 10.1212/WNL.0000000000003509.
    1. Sultana B, Panzini M-A, Veilleux Carpentier A, Comtois J, Rioux B, Gore G, et al. Incidence and prevalence of drug-resistant epilepsy. Neurology. 2021;96(17):805–817. doi: 10.1212/WNL.0000000000011839.
    1. Huang YH, Chi NF, Kuan YC, Chan L, Hu CJ, Chiou HY, et al. Efficacy of phenytoin, valproic acid, carbamazepine and new antiepileptic drugs on control of late-onset post-stroke epilepsy in Taiwan. Eur J Neurol. 2015;22(11):1459–1468. doi: 10.1111/ene.12766.
    1. Halvorsen KH, Johannessen Landmark C, Granas AG. Prevalence of different combinations of antiepileptic drugs and CNS drugs in elderly home care service and nursing home patients in Norway. Epilepsy Res Treat. 2016 doi: 10.1155/2016/5153093.
    1. Tuan NA, Tomson T, Allebeck P, Chuc NTK, Cuong LQ. The treatment gap of epilepsy in a rural district of Vietnam: a study from the EPIBAVI project. Epilepsia. 2009;50(10):2320–2323. doi: 10.1111/j.1528-1167.2009.02298.x.
    1. . . Accessed 15 Sep 2015.
    1. Grimmsmann T, Himmel W. Discrepancies between prescribed and defined daily doses: a matter of patients or drug classes? Eur J Clin Pharmacol. 2011;67(8):847–854. doi: 10.1007/s00228-011-1014-7.
    1. Wang Q, Zhou JQ, Zhou LM, Chen ZY, Fang ZY, Chen SD, et al. Association between HLA-B*1502 allele and carbamazepine-induced severe cutaneous adverse reactions in Han people of southern China mainland. Seizure. 2011;20(6):446–448. doi: 10.1016/j.seizure.2011.02.003.
    1. Panayiotopoulos CP. Principles of therapy in epilepsies. In: Panayiotopoulos CP, editor. The epilepsies seizures, syndromes and management. Oxfordshire: Bladon Medical Publishing; 2005.
    1. Nevitt SJ, Marson AG, Weston J, Tudur SC. Carbamazepine versus phenytoin monotherapy for epilepsy: an individual participant data review. Cochrane Database Syst Rev. 2017;2(2):CS001911. doi: 10.1002/14651858.CD001911.pub3.
    1. St Louis EK, Rosenfeld WE, Bramley T. Antiepileptic drug monotherapy: the initial approach in epilepsy management. Curr Neuropharmacol. 2009;7(2):77–82. doi: 10.2174/157015909788848866.
    1. Hsieh LP, Huang CY. Antiepileptic drug utilization in Taiwan: analysis of prescription using National Health Insurance database. Epilepsy Res. 2009;84(1):21–27. doi: 10.1016/j.eplepsyres.2008.11.018.
    1. Nasir BB, Yifru YM, Engidawork E, Gebrewold MA, Woldu MA, Berha AB. Antiepileptic drug treatment outcomes and seizure-related injuries among adult patients with epilepsy in a tertiary care hospital in Ethiopia. Patient Relat Outcome Meas. 2020;11:119–127. doi: 10.2147/prom.S243867.
    1. Glauser T, Ben-Menachem E, Bourgeois B, Cnaan A, Chadwick D, Guerreiro C, et al. ILAE treatment guidelines: evidence-based analysis of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia. 2006;47(7):1094–1120. doi: 10.1111/j.1528-1167.2006.00585.x.
    1. Horváth L, Fekete K, Márton S, Fekete I. Correlation between prescribed daily dose, seizure freedom and defined daily dose in antiepileptic drug treatment. Int J Clin Pharm. 2017;39(2):459–467. doi: 10.1007/s11096-017-0447-1.
    1. St Louis EK. Minimizing AED adverse effects: improving quality of life in the interictal state in epilepsy care. Curr Neuropharmacol. 2009;7(2):106–114. doi: 10.2174/157015909788848857.
    1. Brodie MJ, Barry SJ, Bamagous GA, Kwan P. Effect of dosage failed of first antiepileptic drug on subsequent outcome. Epilepsia. 2013;54(1):194–198. doi: 10.1111/j.1528-1167.2012.03722.x.
    1. Kwan P, Arzimanoglou A, Berg AT, Brodie MJ, Allen Hauser W, Mathern G, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010;51(6):1069–1077. doi: 10.1111/j.1528-1167.2009.02397.x.
    1. Hilgers A, Schaefer M. Systematic adverse drug reaction monitoring of patients under newer antiepileptic drugs using routine clinical data of inpatients. Drugs Real World Outcomes. 2016;3(2):209–221. doi: 10.1007/s40801-016-0077-2.
    1. French JA, Gazzola DM. New generation antiepileptic drugs: what do they offer in terms of improved tolerability and safety? Ther Adv Drug Saf. 2011;2(4):141–158. doi: 10.1177/2042098611411127.
    1. Carpay JA, Aldenkamp AP, van Donselaar CA. Complaints associated with the use of antiepileptic drugs: results from a community-based study. Seizure. 2005;14(3):198–206. doi: 10.1016/j.seizure.2005.01.008.
    1. Koshy S. Role of pharmacists in the management of patients with epilepsy. Int J Pharm Pract. 2012;20(1):65–68. doi: 10.1111/j.2042-7174.2011.00156.x.
    1. Lertsinudom S, Chaiyakum A, Tuntapakul S, Sawanyawisuth K, Tiamkao S, Tiamkao S, et al. Therapeutic drug monitoring in epilepsy clinic: a multi-disciplinary approach. Neurol Int. 2014;6(4):83–85. doi: 10.4081/ni.2014.5620.
    1. Reis T, Campos M, Nagai M, Pereira L. Contributions of pharmacists in the treatment of epilepsy: a systematic review. Am J Pharm Benefits. 2016;8(3):e55–e60.
    1. Azar NJ, Abou-Khalil BW. Considerations in the choice of an antiepileptic drug in the treatment of epilepsy. Semin Neurol. 2008;28(3):305–316. doi: 10.1055/s-2008-1079335.
    1. Eshiet U, Okonta J, Ukwe C. The efficacy of a pharmacist implemented educational treatment programme for people with epilepsy: a report of a randomised controlled trial. Seizure. 2019;69:147–153. doi: 10.1016/j.seizure.2019.04.011.
    1. Rane CT, Dalvi SS, Gogtay NJ, Shah PU, Kshirsagar NA. A pharmacoeconomic analysis of the impact of therapeutic drug monitoring in adult patients with generalized tonic-clonic epilepsy. Br J Clin Pharmacol. 2001;52(2):193–195. doi: 10.1046/j.0306-5251.2001.01436.x.
    1. Ratanajamit C, Kaewpibal P, Setthawacharavanich S, Faroongsarng D. Effect of pharmacist participation in the health care team on therapeutic drug monitoring utilization for antiepileptic drugs. J Med Assoc Thai. 2009;92(11):1500–1507.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit