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Influence of titration of antiseizure medications on treatment selection: Results of an online survey with clinicians in the United States.
Williams, Betsy; Gidal, Barry E; Resnick, Trevor; Baker, John; Holtzman, Matthew; Sparling, Nicole; Maher, Joshua; Plauschinat, Craig.
Afiliación
  • Williams B; IQVIA, New York City, NY, United States. Electronic address: betsy.williams@us.imshealth.com.
  • Gidal BE; University of Wisconsin School of Pharmacy, Madison, WI, United States.
  • Resnick T; University of Miami School of Medicine, FL, United States; Nicklaus Children's Hospital, Department of Neurology, FL, United States.
  • Baker J; Colonial Healthcare, Colonial Neurology, SC, United States.
  • Holtzman M; Ascension Michigan Providence Hospital, MI, United States.
  • Sparling N; IQVIA, New York City, NY, United States.
  • Maher J; IQVIA, Madrid, Spain.
  • Plauschinat C; Eisai, Woodcliff Lake, NJ, United States.
Epilepsy Behav ; 117: 107840, 2021 04.
Article en En | MEDLINE | ID: mdl-33626489
INTRODUCTION: Most antiseizure medications (ASM) need to be titrated before the optimal dose is achieved. Titration can last several weeks to months. We assessed the impact titration schedules have on ASM treatment-related decisions in the United States (US). METHODS: An online survey was conducted with different healthcare providers (HCPs) in the US involved in the treatment and management of patients with epilepsy. The survey contained three sections: the first section with screening questions; the second on key factors that influence a HCP's decision-making when selecting treatments for different types of seizures and different treatment lines; and the third on the HCP's knowledge and perceptions regarding ASM titration for the treatment of patients with epilepsy. RESULTS: One-hundred and fifty HCPs (63% neurologists) completed the survey. Most HCPs considered titration schedule to be important, with only 1-3% of HCPs, depending on type of seizure, considering the titration schedule to be "not important at all" when prescribing therapy. Healthcare providers' acceptance of titration increased with shorter durations (≥50% accepted titration periods of ≤2 weeks), and lower number of tablets/capsules per dose (≥50% accepted ≤3 tablets/capsules per dose), doses (≥50% accepted ≤2 doses/day), and steps (≥50% accepted ≤3 steps/dose change). Most HCPs (68-91% depending on type of seizure) considered a titration duration of 6 or more weeks only somewhat acceptable or somewhat or highly unacceptable. Almost all HCPs selected "somewhat familiar", "familiar", or "very familiar" as the attribute that best defines their knowledge level of titration, with only 4% selecting "a little familiar". While 87% of HCPs agreed or strongly agreed that they could easily understand titration schedules, only 27% of them agreed or strongly agreed that patients could easily understand titration schedules and 58% of HCPs considered that adhering to the titration schedule was difficult for patients. Most HCPs agreed or strongly agreed that a complex or long titration schedule renders it difficult to achieve their treatment objectives. CONCLUSIONS: Healthcare providers take into account the duration and complexity of the titration period in their ASM prescribing decision-making and prefer shorter and simpler titration schedules, particularly for patients who are experiencing convulsive seizures and starting monotherapy. There was a clear difference between the HCP's belief in their own ability to understand a titration schedule, and their belief that the patient would be able to follow the titration schedule appropriately.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Actitud del Personal de Salud / Personal de Salud Tipo de estudio: Prognostic_studies Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: Epilepsy Behav Asunto de la revista: CIENCIAS DO COMPORTAMENTO / NEUROLOGIA Año: 2021 Tipo del documento: Article Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Actitud del Personal de Salud / Personal de Salud Tipo de estudio: Prognostic_studies Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: Epilepsy Behav Asunto de la revista: CIENCIAS DO COMPORTAMENTO / NEUROLOGIA Año: 2021 Tipo del documento: Article Pais de publicación: Estados Unidos