Assessment of Antiepileptic Drug Concentrations in HIV-Infected versus HIV-Negative Patients

A Retrospective Analysis

Dario Cattaneo, Sara Baldelli, Andrea Giacomelli, Davide Minisci, Paola Meraviglia, Noemi Astuti, Marta Fusi, Valeria Cozzi, Emilio Clementi, Massimo Galli, Cristina Gervasoni

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

Original languageEnglish
Pages (from-to)1345-1350
Number of pages6
JournalClinical Pharmacokinetics
Volume58
Issue number10
DOIs
Publication statusPublished - Oct 1 2019

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Anticonvulsants
HIV
Valproic Acid
Psychotropic Drugs
Pharmaceutical Preparations
Outpatients
Therapeutics
Retrospective Studies

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

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Assessment of Antiepileptic Drug Concentrations in HIV-Infected versus HIV-Negative Patients : A Retrospective Analysis. / Cattaneo, Dario; Baldelli, Sara; Giacomelli, Andrea; Minisci, Davide; Meraviglia, Paola; Astuti, Noemi; Fusi, Marta; Cozzi, Valeria; Clementi, Emilio; Galli, Massimo; Gervasoni, Cristina.

In: Clinical Pharmacokinetics, Vol. 58, No. 10, 01.10.2019, p. 1345-1350.

Research output: Contribution to journalArticle

Cattaneo, D, Baldelli, S, Giacomelli, A, Minisci, D, Meraviglia, P, Astuti, N, Fusi, M, Cozzi, V, Clementi, E, Galli, M & Gervasoni, C 2019, 'Assessment of Antiepileptic Drug Concentrations in HIV-Infected versus HIV-Negative Patients: A Retrospective Analysis', Clinical Pharmacokinetics, vol. 58, no. 10, pp. 1345-1350. https://doi.org/10.1007/s40262-019-00752-6
Cattaneo, Dario ; Baldelli, Sara ; Giacomelli, Andrea ; Minisci, Davide ; Meraviglia, Paola ; Astuti, Noemi ; Fusi, Marta ; Cozzi, Valeria ; Clementi, Emilio ; Galli, Massimo ; Gervasoni, Cristina. / Assessment of Antiepileptic Drug Concentrations in HIV-Infected versus HIV-Negative Patients : A Retrospective Analysis. In: Clinical Pharmacokinetics. 2019 ; Vol. 58, No. 10. pp. 1345-1350.
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AU - Cattaneo, Dario

AU - Baldelli, Sara

AU - Giacomelli, Andrea

AU - Minisci, Davide

AU - Meraviglia, Paola

AU - Astuti, Noemi

AU - Fusi, Marta

AU - Cozzi, Valeria

AU - Clementi, Emilio

AU - Galli, Massimo

AU - Gervasoni, Cristina

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N2 - INTRODUCTION: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

AB - INTRODUCTION: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

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