TERAPIJSKI MONITORING ANTIEPILEPTIKA NOVIJE GENERACIJE KOD PEDIJATRIJSKIH BOLESNIKA: FOKUS NA FAKTORE KOJI UTIČU NA KONCENTRACIJU U PLAZMI
Sažetak
Monitoring koncentracije antiepileptičnih lekova (AEL) u pedijatrijskoj populaciji predstavlja važan korak u kaskadi odluka vezanih za optimizaciju savremene terapije epilepsije. Primarni cilj ovog istraživanja bilo je određivanje koncentracija lamotrigina (LTG) i levetiracetama (LEV) u plazmi dece i adolescenata na kombinovanoj antiepileptičnoj terapiji. Sekundarni cilj bio je ispitati uticaj demografskih faktora i koterapije na izmerene koncentracije AEL-a. Prospektivna studija obuhvatila je sedamdeset jednog ispitanika sa dijagnozom epilepsije, starosti od dve godine do osamnaest godina, na kombinovanoj antiepileptičnoj terapiji koja je uključivala sledeće terapijske modalitete: valproinsku kiselinu (engl. valporic acid – VA) / LTG, VA/LEV i LTG/LEV. Rezultati sprovedenog istraživanja pokazali su da je 86,27% LTG koncentracija i 68,97% LEV koncentracija bilo u referentnom opsegu. Nije zabeležen statistički značajan uticaj komedikacije na koncentracije ispitivanih antiepileptika. Takođe, dobijeni rezultati potvrdili su da je doza LTG-a bila najznačajniji prediktor za koncentracije LTG-a. Rezultati ovog istraživanja ukazali su na to da jedino doza LEV-a korigovana telesnom masom može uticati na LEV koncentracije. Iako se terapijski monitoring antiepileptika novije generacije ne sprovodi rutinski u svakodnevnoj kliničkoj praksi, rezultati našeg istraživanja predočili su da monitoring koncentracija LTG-a i LEV-a može biti od velike koristi u pedijatrijskoj populaciji koja primenjuje kombinovanu antiepileptičnu terapiju, kako zbog same prirode bolesti, tako i zbog potencijalne farkmakokinetičke varijabilnosti ispitivanih antiepileptika.
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