文档介绍：抗癫痫药物临床治疗指南新看点
华山医院
俞丽云
制订临床指南的目的
应用指南是一种系统性阐述,用以帮助职业医师以及患者对于特定临床情况作出适当的医疗决定
临床指南的存在问题
≠不存在的证据
→过时、更新
,有一定的利益因素
Shorvon S. Epilepsia 2006,4).1091~3
制订指南原则
透明:无利益驱动
公平:所有数据采用同样的评估标准
严格:评价方法严格可行
动态:不断更新
抗癫痫治疗指南大事记
Payakachat et al. J Manag Care Pharma 2006
e to the National Institute for Health                     and Clinical Excellence website
      NICE is the anization responsible for providing       national guidance on the promotion of good health and       the prevention and treatment of ill health.
On 1 April 2005 NICE joined with the Health Development Agency to e the new National Institute for Health and Clinical Excellence (also to be known as NICE).
Clinical Excellence                Public Health Excellence
NICE was set up as a Special Health Authority for England and Wales on 1 April 1999. Its role is to provide patients, health professionals and the public with authoritative, robust and reliable guidance on current ‘best practice’. (/)
NICE指南
对于抗癫痫药物使用的指证,药物选择,换药,停药等原则性问题均作出了相应推荐
Ref: National Institute for Health and Clinical Excellence. Technology appraisal
guidance 76: newer drugs for epilepsy in adults. Available at:
/TA076guidance. Accessed July 5, 2005.
NICE在治疗中
①尽可能选择单药治疗
②不推荐常规监测看癫痫药物的血药浓度
③停药原则
NICE指南
Ref: National Institute for Health and Clinical Excellence. Technology appraisal
guidance 76: newer drugs for epilepsy in adults. Available at:
/TA076guidance. Accessed July 5, 2005.
NICE指南
目前仍缺乏高质量的临床试验支持新药单药治疗比传统药物更有效
研究中的药物副作用和耐受性并未提供足够多且一致的结果支持新药优于传统药物
仅9项比较新药和老药单药治疗新诊断癫痫患者生活质量的研究,未提供强有力的证据支持新药提高患者生活质量
传统抗癫痫药物单药治疗费用更便宜
Ref: National Institute for Health and Clinical Excellence. Technology appraisal
guidance 76: newer drugs for epilepsy in adults. Available at:
/TA076guidance. Accessed July 5, 2005.
首选单药治疗药物应为传统抗癫痫药物如丙戊酸钠或卡马西平,除如下原因:
禁忌症
与患者目前服用的药物有潜在的相互作用
患者在既往治疗中对该药耐受性差
患者处于准备生育期
新型抗癫痫药物作为初始治疗的二线选择
Ref: National Institute for Health and Clinical Excel