Portal de Periódicos da CAPES

Obesity and overweight as CAE comorbidities and differential drug response modifiers

2016; Lippincott Williams & Wilkins; Volume: 86; Issue: 17 Linguagem: Inglês

10.1212/wnl.0000000000002611

1526-632X

Ravindra Arya, Catherine W. Gillespie, Avital Cnaan, Mahima Devarajan, Peggy O. Clark, Shlomo Shinnar, Alexander A. Vinks, Kana Mizuno, Tracy A. Glauser, Harry S. Abram, Ellen Albers, Karen Ballaban‐Gil, José E. Barrera, Mary Bertrand, Sarah Borror, Charlie Borzy, Susan Brantz, Candace Cardoza, Kevin Chapman, Harry T. Chugani, Robert R. Clancy, Yong Collins, Terrie Conklin, Joan A. Conry, Patricia K. Crumrine, Jason Czachor, Maryland Dean, Sandra Dewar, Michael Duchowny, Tammy L. Eaton, Mary Jo Elgie, Michelle Ellis, Roy D. Elterman, Andrew Francis, Loren M. Frank, La June Grayson, May L. Griebel, Laurie Guidry, Samantha Hagopian, Amelia Halac, Angel Hernandez, Howard Lee, Krisa Hoyle Elgin, Pong Kankirawatana, Kent R. Kelley, Juli Kidd, Divya S. Khurana, Paul M. Levisohn, Donna Lowery, Ángela Martínez, Karen McEwen, Sarah J. McVey, Mary Miceli, Daniel K. Miles, Dianne Morus, JoAnn Narus, Mark Nespeca, Edward J. Novotny, Suzanne Oken, Juliann Paolicchi, Bryan Philbrook, Amber Reese-Porter, Jong M. Rho, Angela Riggs, Colin Roberts, Kathy Romine, Russell P. Saneto, Raman Sankar, Mark S. Scher, Rebecca Schultz, Dina Schwam, Sagar Shah, Rolla Shbarou, Ruth C. Shinnar, Márcio Sotero de Menezes, Susanna Taylor, Mamello Tekateka, Doris A. Trauner, Edwin Trevathan, William R. Turk, Colin B. Van Orman, Arie Weinstock, Rhonda Werner, James W. Wheless, Angus A. Wilfong, Shelley Williams, Teresa A. Williams, Khaled Zamel, Mary L. Zupanc,

Diet and metabolism studies

Objective: This study examined whether overweight and obesity are pretreatment comorbidities and predictors of short-term drug response in newly diagnosed untreated childhood absence epilepsy (CAE). We also examined whether dietary intake accounts for observed pretreatment body mass index (BMI) distribution. Methods: Pretreatment height and weight were available for 445 of 446 participants in the NIH-funded CAE comparative effectiveness trial (NCT00088452). Twenty-four-hour dietary recalls were collected. Calculated BMI and dietary intake were standardized for age, sex, and race/ethnicity and compared to age-matched US population from the National Health and Nutrition Examination Survey (NHANES). Logistic regression models tested BMI as a predictor of treatment response. Pharmacokinetic variables were explored as contributors to differential drug response. Results: After standardizing for demographic differences, children with CAE were more likely to be overweight (19.3% vs 13.8%; p < 0.001) or obese (14.5% vs 11.5%; p < 0.001) than NHANES controls. The combined prevalence of overweight and obesity was 33.8% in the CAE cohort and 25.3% among controls ( p < 0.001). Mean daily energy intake (difference −79.5 kcal/day, p = 0.04) and daily carbohydrate intake (difference −10.7 g/day, p = 0.04) were lower in the CAE group than in NHANES controls. With increasing baseline BMI z score, the efficacy and effectiveness of ethosuximide and valproic acid over lamotrigine became more pronounced, despite no significant differences in drug exposure and trough levels. Conclusions: Overweight and obesity are more prevalent in children with newly diagnosed CAE than in age-matched peers, despite lower caloric and carbohydrate intake. Baseline BMI may also predict differential drug response, which cannot be attributed to pharmacokinetic differences.