在患有的妇女中,与抗发作药物双疗相关的生风险
Frank J E Vajda1, Terence J O'Brien2, Janet E Graham3
1Departments of Medicine and Neurosciences, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC 3050, Australia; Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia; Department of Neurology, Alfred Health, Melbourne, VIC 3004, Australia.
Epilepsy research
|February 10, 2024
概括
结合两种原性抗发作药物会增加胎儿形的风险. 拉莫特里金与毒性药物结合使用时似乎更安全,而不是与瓦尔酸盐或卡巴马泽平等已知的毒性药物结合使用.
科学领域:
- 产科和妇科 产科和妇科
- 神经学 神经学
- 甲状腺学 甲状腺学
背景情况:
- 在怀孕期间治疗需要仔细考虑药物风险.
- 抗发作药物 (ASM) 在它们的性潜力方面有所不同.
- 了解与ASM双疗法相关的风险对于明智的临床决策至关重要.
研究的目的:
- 评估孕妇暴露于双重抗发作药物 (双疗法) 的胎儿形 (FM) 率.
- 在患有的女性中,比较不同ASM组合之间的FM风险.
- 为了确定更安全的ASM组合用于的孕妇.
主要方法:
- 来自澳大利亚怀孕登记册的524例怀孕的分析.
- 调查 FM 怀孕率在同时暴露于两个 ASM 的子宫内.
- 根据二疗法中使用的ASM的致性分类来比较FM病率.
主要成果:
- 与单独治疗相比,结合两种已确定的致病性ASM (瓦尔酸盐,托皮拉酸盐,卡巴马泽) 时,FM怀孕率更高.
- 与克洛纳泽帕姆或 levetiracetam 结合已确立的原体也显示了增加的 FM 率,但在较小的程度上.
- 将拉莫特里金与已确定的原体结合起来,导致FM的发病率低于用原性ASM单独治疗.
结论:
- 由于胎儿形风险增加,避免结合已确定的致病性ASM (卡巴马泽平,瓦尔酸,托皮拉玛酸).
- 当将一种已确定的致病性ASM与一种不那么致病性的ASM相结合时,拉莫特里金似乎是更安全的选择.
- 临床决策应权衡发作控制与ASM组合对胎儿发育的潜在风险.
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