Antiseizure medication-induced hypersensitivity reactions: Data from a large healthcare system.

Allergy Anti-epileptic drug Anti-seizure medication Hypersensitivity Rash

Journal

Seizure
ISSN: 1532-2688
Titre abrégé: Seizure
Pays: England
ID NLM: 9306979

Informations de publication

Date de publication:
03 Oct 2024
Historique:
received: 01 07 2024
accepted: 24 09 2024
medline: 26 10 2024
pubmed: 26 10 2024
entrez: 25 10 2024
Statut: aheadofprint

Résumé

Data on hypersensitivity reactions (HR) to individual anti-seizure medications (ASMs), and reactions to additional ASMs, is often limited by sample size. This data is vital in helping clinicians identify initial and subsequent ASMs to use in treating persons with epilepsy (PWE). Using a very large dataset, our study attempts to quantify the occurrence of HR across 31 different ASMs. We also attempt to investigate whether certain pairs of ASMs are associated with a higher frequency of HR. The Slicer-Dicer tool in the Epic electronic medical records system was used to analyze patients seen between 2012 and 2022 at a large healthcare system in Kentucky with recorded exposures to 31 different ASMs. Incidence of HR with these ASMs were identified, both with single drugs or pairs of drugs, as well as incidence of HR stratified by sex and ASM structure. A total of 573,571 patients with 967,168 exposures were analyzed. Phenobarbital had the highest rate of HR at 12.9 %. Usage of aromatic ASMs were most associated with patients having HR to other ASMs. HR to 13/31 studied ASMs was more likely to occur in females, while HR was more likely in males with lacosamide. Aromatic ASMs were more likely (p < 0.0001) to be associated with HR compared to non-aromatic ASMs. Carbamazepine and the related drugs oxcarbazepine and eslicarbazepine were associated with the greatest number of drug pairings in which the patient had HR to both medications at any time point. Our data reveals important patterns in HR to ASMs that may be valuable to clinicians treating PWE. Clinicians should monitor closely for HR when beginning a new ASM in a patient who has taken an aromatic ASM, especially carbamazepine, oxcarbazepine, or eslicarbazepine as well as phenobarbital.

Sections du résumé

BACKGROUND AND OBJECTIVES OBJECTIVE
Data on hypersensitivity reactions (HR) to individual anti-seizure medications (ASMs), and reactions to additional ASMs, is often limited by sample size. This data is vital in helping clinicians identify initial and subsequent ASMs to use in treating persons with epilepsy (PWE). Using a very large dataset, our study attempts to quantify the occurrence of HR across 31 different ASMs. We also attempt to investigate whether certain pairs of ASMs are associated with a higher frequency of HR.
METHODS METHODS
The Slicer-Dicer tool in the Epic electronic medical records system was used to analyze patients seen between 2012 and 2022 at a large healthcare system in Kentucky with recorded exposures to 31 different ASMs. Incidence of HR with these ASMs were identified, both with single drugs or pairs of drugs, as well as incidence of HR stratified by sex and ASM structure.
RESULTS RESULTS
A total of 573,571 patients with 967,168 exposures were analyzed. Phenobarbital had the highest rate of HR at 12.9 %. Usage of aromatic ASMs were most associated with patients having HR to other ASMs. HR to 13/31 studied ASMs was more likely to occur in females, while HR was more likely in males with lacosamide. Aromatic ASMs were more likely (p < 0.0001) to be associated with HR compared to non-aromatic ASMs. Carbamazepine and the related drugs oxcarbazepine and eslicarbazepine were associated with the greatest number of drug pairings in which the patient had HR to both medications at any time point.
DISCUSSION CONCLUSIONS
Our data reveals important patterns in HR to ASMs that may be valuable to clinicians treating PWE. Clinicians should monitor closely for HR when beginning a new ASM in a patient who has taken an aromatic ASM, especially carbamazepine, oxcarbazepine, or eslicarbazepine as well as phenobarbital.

Identifiants

DOI: 10.1016/j.seizure.2024.09.018 PMID: 39454220
pubmed: 39454220
pii: S1059-1311(24)00266-8
doi: 10.1016/j.seizure.2024.09.018
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

172-178

Informations de copyright

Copyright © 2024 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interest The authors report no disclosures or conflicts of interest.

Auteurs

Benjamin Cadle (B)

Division of Child Neurology, Department of Pediatrics, University of Louisville School of Medicine, KY, 40202, USA. Electronic address: Benjamin.cadle@louisville.edu.

Feride Un Candan (FU)

Division of Child Neurology, Department of Pediatrics, University of Louisville School of Medicine, KY, 40202, USA.

Zulfi Haneef (Z)

Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA; Neurology Care Line, VA Medical Center, Houston, TX 77030, USA.

Christopher Ryan Barton (CR)

Division of Child Neurology, Department of Pediatrics, University of Louisville School of Medicine, KY, 40202, USA; Norton Children's Neuroscience Institute and Children's Hospital, Louisville, KY 40202, USA.

Dylan Brock (D)

Division of Child Neurology, Department of Pediatrics, University of Louisville School of Medicine, KY, 40202, USA; Norton Children's Neuroscience Institute and Children's Hospital, Louisville, KY 40202, USA.

Irfan Ali (I)

Department of Pediatrics, Section of Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, TX 77030, USA.

Jaime Shoup (J)

Division of Child Neurology, Department of Pediatrics, University of Louisville School of Medicine, KY, 40202, USA; Norton Children's Neuroscience Institute and Children's Hospital, Louisville, KY 40202, USA.

Cemal Karakas (C)

Division of Child Neurology, Department of Pediatrics, University of Louisville School of Medicine, KY, 40202, USA; Norton Children's Neuroscience Institute and Children's Hospital, Louisville, KY 40202, USA.

Classifications MeSH