info:eu-repo/semantics/article
Declining malformation rates with changed antiepileptic drug prescribing: An observational study
Fecha
2019-08Registro en:
Tomson, Torbjörn; Battino, Dina; Thomas, Sanjeev V.; Vajda, Frank; Kochen, Sara Silvia; et al.; Declining malformation rates with changed antiepileptic drug prescribing: An observational study; NLM (Medline); Neurology; 93; 9; 8-2019; 831-840
1526-632X
CONICET Digital
CONICET
Autor
Tomson, Torbjörn
Battino, Dina
Thomas, Sanjeev V.
Vajda, Frank
Kochen, Sara Silvia
Craig, John
Binozzoni, Erminio
Lindhout, Dick
Perucca, Emilio
Sabers, Anne
Resumen
Objective Changes in prescribing patterns of antiepileptic drugs (AEDs) in pregnant women with epilepsy would be expected to affect the risk of major congenital malformations (MCMs). To test this hypothesis, we analyzed data from an international pregnancy registry (EURAP). Methods EURAP is an observational prospective cohort study designed to determine the risk of MCMs after prenatal exposure to AEDs. The Cochrane-Armitage linear trend analysis was used to assess changes in AED treatment, prevalence of MCMs, and occurrence of generalized tonic-clonic seizures (GTCs) over 3 time periods: 2000–2005 (n = 4,760), 2006–2009 (n = 3,599), and 2010–2013 (n = 2,949). Results There were pronounced changes in the use of specific AEDs over time, with a decrease in the use of valproic acid and carbamazepine and an increase in the use of lamotrigine and levetiracetam. The prevalence of MCMs with monotherapy exposure decreased from 6.0% in 2000–2005 to 4.4% in 2010–2013. The change over time in MCM frequency after monotherapy exposure showed a significant linear trend in the crude analysis (p = 0.0087), which was no longer present after adjustment for changes in AED treatment (p = 0.9923). There was no indication of an increase over time in occurrence of GTCs during pregnancy. Conclusions There have been major changes in AED prescription patterns over the years covered by the study. In parallel, we observed a significant 27% decrease in the prevalence of MCMs. The results of adjusting the trend analysis for MCMs for changes in AED treatment suggest that changes in prescription patterns played a major role in the reduction of teratogenic events.