Epilepsy in Asia
2019; Wiley; Volume: 60; Issue: S1 Linguagem: Inglês
10.1111/epi.14507
ISSN1528-1167
Autores Tópico(s)Drug Transport and Resistance Mechanisms
ResumoEpilepsiaVolume 60, Issue S1 p. 5-6 EDITORIALFree Access Epilepsy in Asia Eugen Trinka, Corresponding Author Eugen Trinka [email protected] orcid.org/0000-0002-5950-2692 Department of Neurology, Christian Doppler Klinik, University Hospital Paracelsus Medical University, Salzburg, Austria Institute of Public Health, Medical Decision Making and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology, UMIT, Hall in Tyrol, Austria Correspondence Eugen Trinka, Department of Neurology, Christian Doppler Klinik, University Hospital Paracelsus Medical University, Salzburg, Austria. Email: [email protected]Search for more papers by this authorByungin Lee, Byungin Lee Department of Neurology, Inje University School of Medicine, Haeundae Paik Hospital, Busan, South KoreaSearch for more papers by this author Eugen Trinka, Corresponding Author Eugen Trinka [email protected] orcid.org/0000-0002-5950-2692 Department of Neurology, Christian Doppler Klinik, University Hospital Paracelsus Medical University, Salzburg, Austria Institute of Public Health, Medical Decision Making and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology, UMIT, Hall in Tyrol, Austria Correspondence Eugen Trinka, Department of Neurology, Christian Doppler Klinik, University Hospital Paracelsus Medical University, Salzburg, Austria. Email: [email protected]Search for more papers by this authorByungin Lee, Byungin Lee Department of Neurology, Inje University School of Medicine, Haeundae Paik Hospital, Busan, South KoreaSearch for more papers by this author First published: 14 March 2019 https://doi.org/10.1111/epi.14507Citations: 2AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL INTRODUCTION Epilepsies are a global public health problem affecting approximately 50 million people, 80% of whom live in low- and middle-income countries.1 Epilepsies are associated with a high social, psychological, and economic burden for patients, particularly in Asian countries, where the stigma of epilepsy remains high and discrimination against people with epilepsy is common.1, 2 The risk of premature death among patients with epilepsy is approximately 2–3 times higher than that in the general population, but is up to 5 times greater in Asian cohorts.3-5 Premature death may be related to the underlying cause of the disease, comorbidities, accidents occurring during a seizure, status epilepticus, sudden unexplained death in epilepsy, or suicide.1 Asia is a diverse region, with heterogeneous economies and differing healthcare systems; thus access to treatment varies throughout the region. Limited resources, lack of access to treatment, stigmatization, cultural beliefs, and lack of knowledge exclude up to 90% of people with epilepsy in low-income countries from being adequately treated. In fact, the magnitude of the treatment gap is highest in Asia,6 which is also the most highly populated region in the globe. Conversely, poor seizure control contributes to low educational achievement, poor employment opportunities and productivity, increased morbidity and mortality, and reduced quality of life. Antiepileptic drugs (AEDs) are more widely available in urban than in rural areas of Asia, and their supply is notoriously unreliable in rural areas, where lack of financial resources can result in treatment interruption. Newer AEDs, with more favorable safety profiles, may not be available in all countries. Epilepsy specialists also tend to be accessible only in urban areas. There is limited epilepsy research coming from Asian countries, and standardized epidemiologic and surveillance studies are needed to provide comparative data across the region. Furthermore, results of clinical trials performed in European or North American countries do not necessarily translate to Asian populations who may experience variability in drug response due to a different genetic background. For example, there are significant racial differences in the degree of hepatic CYP isoenzyme expression,7 and AED-induced cutaneous adverse reactions may occur more frequently in Han Chinese and Thai populations.8, 9 Perampanel is a new noncompetitive α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate (AMPA) receptor antagonist that has been approved as adjunctive therapy for focal seizures with or without secondary generalization and primary generalized tonic–clonic seizures, and as monotherapy for focal seizures. Perampanel is now available in more than 55 countries, including in Asia. The pivotal, randomized, double-blind, placebo-controlled phase 3 clinical trials were performed among global populations,10-14 and the data for Asian patients have been analyzed separately and are reported in this supplement. The first article of this supplement describes the burden of epilepsy in Asia and reviews the current management and treatment challenges.15 In the second article, Potschka and Trinka assess the profile of perampanel and its potential for broad-spectrum use.16 In the following 3 articles, the data for perampanel use in Asian patients enrolled in phase 3 clinical trials are reported. Tsai et al17 assess the efficacy, safety, and tolerability of perampanel as adjunctive therapy in Asian patients with focal epilepsy with or without secondary generalization; Nishida et al18 examine its efficacy and safety in Asian patients with primary or secondarily generalized tonic–clonic seizures; and Inoue et al19 investigate the long-term use of perampanel in Asian patients with refractory focal seizures or complex partial seizures with or without secondary generalization. The 3 studies each found that the efficacy, safety, and tolerability of perampanel in Asian patients were similar to the results for the non-Asian patients in phase 3 trials, suggesting a benefit also for this patient population. The challenge for the future is to reduce the treatment gap in Asia through standardized research, implementation of evidence-based epilepsy guidance for low- and middle-income countries, and better availability of effective AEDs. Given the results for Asian patients, the addition of perampanel to the treatment armamentarium increases the choice of AEDs in this part of the world. ACKNOWLEDGMENT This manuscript was developed with editorial assistance provided by Mary Smith through an unrestricted grant supported by Eisai Co. Ltd. DISCLOSURES OF CONFLICTS OF INTEREST Eugen Trinka has acted as a paid consultant to Eisai, EVER Neuro Pharma, Biogen Idec, Medtronics, Bial, and UCB and has received speakers' honoraria from Bial, Eisai, Boehringer Ingelheim, Biogen, Newbridge, Novartis, and UCB Pharma in the past 3 years. Eugen Trinka has received research funding from UCB Pharma, Biogen, Novartis, Bayer, Eisai, Red Bull, Merck, the European Union, FWF Österreichischer Fond zur Wissenschaftsförderung, and Bundesministerium für Wissenschaft und Forschung. Eugen Trinka is also part of the investigators planning the ESET Trial and member of the Task Force on Classification of Status Epilepticus of the International League Against Epilepsy (ILAE). There is no conflict of interest related to this publication. Byungin Lee has no conflict of interests to declare. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. REFERENCES 1 World Health Organization Regional Office for South-East Asia and International Bureau for Epilepsy. Epilepsy In the South-East Asia region; bridging the gap. Available from: www.who.int/mental_health/neurology/epilepsy/searo_report.pdf Accessed 30 August 2017. 2Tanywe A, Matchawe C, Fernandez R. The experiences of people living with epilepsy in developing countries: a systematic review of qualitative evidence. JBI Database System Rev Implement Rep. 2016; 14: 136– 92. 3Chen Z, Liew D, Kwan P. Excess mortality and hospitalized morbidity in newly treated epilepsy patients. Neurology. 2016; 87: 718– 25. 4Granbichler CA, Oberaigner W, Kuchukhidze G, et al. Cause-specific mortality in adult epilepsy patients from Tyrol, Austria: hospital-based study. J Neurol. 2015; 262: 126– 33. 5Trinka E, Bauer G, Oberaigner W, et al. Cause-specific mortality among patients with epilepsy: results from a 30-year cohort study. Epilepsia. 2013; 54: 495– 501. 6Mbuba CK, Ngugi AK, Newton CR, et al. The epilepsy treatment gap in developing countries: a systematic review of the magnitude, causes, and intervention strategies. Epilepsia. 2008; 49: 1491– 503. 7Urban TJ. Race, ethnicity, ancestry, and pharmacogenetics. Mt Sinai J Med. 2010; 77: 133– 9. 8Chen CB, Hsiao YH, Wu T, et al. Risk and association of HLA with oxcarbazepine-induced cutaneous adverse reactions in Asians. Neurology. 2017; 88: 78– 86. 9Tassaneeyakul W, Prabmeechai N, Sukasem C, et al. Associations between HLA class I and cytochrome P450 2C9 genetic polymorphisms and phenytoin-related severe cutaneous adverse reactions in a Thai population. Pharmacogenet Genomics. 2016; 26: 225– 34. 10French JA, Krauss GL, Biton V, et al. Adjunctive perampanel for refractory partial-onset seizures: randomized phase III study 304. Neurology. 2012; 79: 589– 96. 11French JA, Krauss GL, Steinhoff BJ, et al. Evaluation of adjunctive perampanel in patients with refractory partial-onset seizures: results of randomized global phase III study 305. Epilepsia. 2013; 54: 117– 25. 12Krauss GL, Serratosa JM, Villanueva V, et al. Randomized phase III study 306: adjunctive perampanel for refractory partial-onset seizures. Neurology. 2012; 78: 1408– 15. 13French JA, Krauss GL, Wechsler RT, et al. Perampanel for tonic-clonic seizures in idiopathic generalized epilepsy: A randomized trial. Neurology. 2015; 85: 950– 7. 14Nishida T, Kaneko S, Inoue Y, et al. A randomized double-blind, placebo-controlled study to evaluate the efficacy and safety of perampanel as adjunctive therapy in patients with refractory partial-onset seizures from the Asia-Pacific region. 69th American Epilepsy Society (AES) Annual Meeting, 2015; Abstract 3.256. 15Trinka E, Kwan P, Lee BI, et al. Epilepsy in Asia: Disease burden, management barriers and challenges. Epilepsia. 2019; 60(Suppl 1): 7– 21. 16Potschka H, Trinka E. Perampanel: Does it have broad-spectrum potential? Epilepsia. 2019; 60(Suppl 1): 22– 36. 17Tsai JJ, Ikeda A, Hong SB, et al. Efficacy, safety, and tolerability of perampanel in Asian and non-Asian patients with epilepsy. Epilepsia. 2019; 60(Suppl 1): 37– 46. 18Nishida T, Lee SK, Wu T, et al. Efficacy and safety of perampanel in generalized and focal to bilateral tonic-clonic seizures: A comparative study of Asian and non-Asian populations. Epilepsia. 2019; 60(Suppl 1): 47– 59. 19Inoue Y, Kaneko S, Hsieh PF, et al. A post hoc analysis of the long-term safety and efficacy of perampanel in Asian patients with epilepsy. Epilepsia. 2019; 60(Suppl 1): 60– 67. Citing Literature Volume60, IssueS1Special Issue: Epilepsy and Perampanel: Asian Perspective. Publication of this supplement was supported by Eisai Co., Ltd.March 2019Pages 5-6 ReferencesRelatedInformation
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