Comparison of levetiracetam versus phenytoin/fosphenytoin for busulfan seizure prophylaxis at a pediatric institution.
Adolescent
Adult
Anticonvulsants
/ therapeutic use
Busulfan
/ adverse effects
Child
Child, Preschool
Drug Administration Schedule
Female
Hematopoietic Stem Cell Transplantation
Humans
Incidence
Infant
Levetiracetam
/ therapeutic use
Male
Myeloablative Agonists
/ adverse effects
Phenytoin
/ therapeutic use
Retrospective Studies
Seizures
/ chemically induced
Transplantation Conditioning
/ adverse effects
Treatment Outcome
Young Adult
complications
hematopoietic stem cell transplant
hematopoietic stem cell transplantation
medication
outcome
pediatric hematopoietic stem cell
Journal
Pediatric transplantation
ISSN: 1399-3046
Titre abrégé: Pediatr Transplant
Pays: Denmark
ID NLM: 9802574
Informations de publication
Date de publication:
Jun 2021
Jun 2021
Historique:
received:
27
11
2020
accepted:
31
03
2021
pubmed:
25
4
2021
medline:
19
1
2022
entrez:
24
4
2021
Statut:
ppublish
Résumé
Busulfan is a chemotherapy agent used in hematopoietic stem cell transplant (HSCT) conditioning regimens. Busulfan is associated with tonic-clonic seizures in ~10% of patients if administered without seizure prophylaxis. Historically, phenytoin was the most commonly utilized seizure prophylaxis agent; however, phenytoin is associated with CYP450 drug interactions and potentially increases the clearance of busulfan. Levetiracetam is being used more recently for busulfan seizure prophylaxis and is not associated with drug-drug interactions; however, data supporting use in pediatric patients are limited. The primary objective is to determine whether there is any difference in seizure rates or safety profile between phenytoin and levetiracetam when used for seizure prophylaxis. We conducted a retrospective chart review including patients who received busulfan between 2010 and 2019 were identified. The data were evaluated to compare the incidence of busulfan-induced seizures in HSCT patients receiving either phenytoin or levetiracetam and to determine the impact of drug-drug interactions on treatment outcomes/adverse events. A total of 342 patients were included with a median age of six years. Overall, five patients within the phenytoin group (n = 126) (4%) and zero patients in the levetiracetam group (n = 216) experienced a seizure (P = .007). There were no differences in liver enzyme elevations, recurrence rates of primary disease, and veno-occlusive disease. Levetiracetam is effective at preventing seizures associated with busulfan administration with no clinically significant adverse effects when compared to phenytoin.
Substances chimiques
Anticonvulsants
0
Myeloablative Agonists
0
Levetiracetam
44YRR34555
Phenytoin
6158TKW0C5
Busulfan
G1LN9045DK
Types de publication
Comparative Study
Evaluation Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14026Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Floeter AE, McCune JS. Levetiracetam for the prevention of busulfan-induced seizures in pediatric hematopoietic cell transplantation recipients. J Oncol Pharm Pract. 2017;23(5):344-349. https://doi.org/10.1177/1078155216651128
Eberly AL, Anderson GD, Bubalo JS, McCune JS. Optimal prevention of seizures induced by high-dose busulfan. Pharmacotherapy. 2008;28(12):1502-1510. https://doi.org/10.1592/phco.28.12.1502
Busulfex ® [package insert]. Greenville, NC: DSM Pharmaceuticals Inc; 2015.
DeToledo JC, Ramsay RE. Fosphenytoin and phenytoin in patients with status epilepticus. Drug Saf. 2000;22(6):459-466. https://doi.org/10.2165/00002018-200022060-00004
Dilantin ® [package insert]. New York, NY: Pfizer Inc; 2018.
Hassan M, Öberg G, Björkholm M, Wallin I, Lindgren M. Influence of prophylactic anticonvulsant therapy on high-dose. Cancer Chemother Pharmacol. 1993;33(3):181-186. https://doi.org/10.1007/BF00686213
Soni S, Skeens M, Termuhlen AM, Bajwa RPS, Gross TG, Pai V. Levetiracetam for busulfan-induced seizure prophylaxis in children undergoing hematopoietic stem cell transplantation. Pediatr Blood Cancer. 2012;59(4):762-764. https://doi.org/10.1002/PBC.24126
Marcus R, Goldman J. Convulsions due to high-dose busulphan. Lancet. 1984;324(8417-8418):1463. https://doi.org/10.1016/s0140-6736(84)91649-0
Akiyama K, Kume T, Fukaya M, et al. Comparison of levetiracetam with phenytoin for the prevention of intravenous busulfan-induced seizures in hematopoietic cell transplantation recipients. Cancer Chemother Pharmacol. 2018;82(4):717-721. https://doi.org/10.1007/s00280-018-3659-8
Leon-Rodriguez E, Rivera-Franco MM. Minimal incidence of neurotoxicity without prophylaxis during busulfan-based conditioning regimen in patients undergoing stem cell transplantation. Int J Hematol. 2016;104(6):644-646. https://doi.org/10.1007/s12185-016-2098-8
Caselli D, Rosati A, Faraci M, et al. Risk of seizures in children receiving busulphan-containing regimens for stem cell transplantation. Biol Blood Marrow Transplant. 2014;20(2):282-285. https://doi.org/10.1016/j.bbmt.2013.10.028
McCune JS, Wang T, Bo-Subait K, et al. Association of antiepileptic medications with outcomes after allogeneic hematopoietic cell transplantation with busulfan/cyclophosphamide conditioning. Biol Blood Marrow Transplant. 2019;25(7):1424-1431. https://doi.org/10.1016/j.bbmt.2019.03.001
Fitzsimmons WE, Ghalie R, Kaizer H. Anticonvulsants and busulfan. Ann Intern Med. 1990;112:552-553.
Ramael S, De Smedt F, Toublanc N, et al. Single-dose bioavailability of levetiracetam intravenous infusion relative to oral tablets and multiple-dose pharmacokinetics and tolerability of levetiracetam intravenous infusion compared with placebo in healthy subjects. Clin Ther. 2006;28:734-744.
Tan J, Paquette V, Levine M, Ensom MHH. Levetiracetam clinical pharmacokinetic monitoring in pediatric patients with epilepsy. Clin Pharmacokinet. 2017;56:1267-1285.
Perucca E, Gidal BE, Baltès E. Effects of antiepileptic comedication on levetiracetam pharmacokinetics: a pooled analysis of data from randomized adjunctive therapy trials. Epilepsy Res. 2003;53:47-56.