Article

OBJECTIVE: To compare our rates of appropriate therapeutic drug monitoring (TDM)
with those defined in the French guidelines for measuring drug levels of
antiepileptic drugs (AEDs) during the pre- and post-medical/pharmaceutical
interventional periods. METHODS: This study was prospectively carried out at a
tertiary center (epilepsy unit of the Pitie-Salpetriere Hospital in Paris) between 2013 and 2016 over three time periods. Criteria for appropriateness were
those stated in the current French guidelines. The main outcome measure was the
percentage of drug level measurements with an appropriate indication, while a
second outcome measure was the impact of education on clinical practice. RESULTS:
Of the 698 AED level measurements requested, 84% overall were found to have
appropriate indications ranging from 75% to 90%, according to French guideline
criteria. Rates of appropriate indications for the three most commonly used
individual AEDs-valproate, carbamazepine and lamotrigine-were 79.6%, 77.3% and
90.7%, respectively, whereas the requests considered to not have an appropriate
indication involved the majority (63.5%) of cases of routine drug monitoring. In
addition, dedicated education seems to substantially increase rates of
appropriateness. CONCLUSION: At our center, 84% of AED level determinations had
an appropriate indication according to a priori defined and reliable criteria.
Moreover, it was noted that a specific educational intervention substantially
increased rates of appropriateness. Thus, it appears to be crucial to ensure that
medical and paramedical staff are aware of the official recommendations to avoid
taking unnecessary drug level measurements.
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Langue : ANGLAIS