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• W2083008384 abstract "Berthold Rzany and co-workers (June 26, p 2190)1Rzany B Correia O Kelly JP et al.Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis during first weeks of antiepileptic therapy: a case-control study.Lancet. 1999; 353: 2190-2194Summary Full Text Full Text PDF PubMed Scopus (285) Google Scholar report the relative risk of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis, associated with antiepileptic therapy. Although they present convincing data for an association with all antiepileptic drugs combined (adjusted relative risk 242 [95% CI 55–999]), the data for individual drugs are not convincing because of small numbers of exposed patients and an inability to adjust for possible confounders. Only three patients, for example, were exposed to lamotrigine.We did an observational study on lamotrigine use in general practice in England, by prescription-event monitoring.2Mackay FJ Wilton LV Pearce GL Freemantle SN Mann RD Safety of long term lamotrigine in epilepsy.Epilepsia. 1997; 38: 881-886Crossref PubMed Scopus (138) Google Scholar We reported 12 cases of SJS among 11316 patients, ten of whom had the diagnosis confirmed by a hospital consultant. The incidence of SJS was 0·1/1000 patient-months of treatment–several times higher than the estimated incidence in the general population.3Royeau JC Kelly JP Naldi L et al.Medication use and the risk of Stevens-Johnson syndrome or toxic epiderma necrolysis.N EnglJ Med. 1995; 333: 1600-1607Crossref PubMed Scopus (1216) Google Scholar All cases occurred in the first 8 weeks of treatment. Our results therefore support Rzany and colleagues' conclusions on lamotrigine. A notable feature of our study, however, was that 42% (five of 12) of cases were in children younger than 12 years. The estimated incidence of SJS in this age-group was 0·34, compared with 0·08/1000 patient-months of treatment in people older than 12 years (relative risk 4·11 [95% CI 1·30–12·95]). The incidence of SJS normally peaks between ages 20 years and 40 years. All the children with confirmed SJS were also taking sodium valproate, which doubles the half-life of lamotrigine.4Summary of Product Characteristics. Lamictal.ABPI compendium of data sheets and summary of product characteristics, 1999–2000. Datapharm Publications Ltd, London1999Google ScholarThus, that neither short-term nor long-term use of valproic acid seems to increase the risk of SJS may be true if it refers only to monotherapy, but sodium valproate could be implicated in the cause of this disorder when lamotrigine is used as add-on therapy, as is common in children. Berthold Rzany and co-workers (June 26, p 2190)1Rzany B Correia O Kelly JP et al.Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis during first weeks of antiepileptic therapy: a case-control study.Lancet. 1999; 353: 2190-2194Summary Full Text Full Text PDF PubMed Scopus (285) Google Scholar report the relative risk of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis, associated with antiepileptic therapy. Although they present convincing data for an association with all antiepileptic drugs combined (adjusted relative risk 242 [95% CI 55–999]), the data for individual drugs are not convincing because of small numbers of exposed patients and an inability to adjust for possible confounders. Only three patients, for example, were exposed to lamotrigine. We did an observational study on lamotrigine use in general practice in England, by prescription-event monitoring.2Mackay FJ Wilton LV Pearce GL Freemantle SN Mann RD Safety of long term lamotrigine in epilepsy.Epilepsia. 1997; 38: 881-886Crossref PubMed Scopus (138) Google Scholar We reported 12 cases of SJS among 11316 patients, ten of whom had the diagnosis confirmed by a hospital consultant. The incidence of SJS was 0·1/1000 patient-months of treatment–several times higher than the estimated incidence in the general population.3Royeau JC Kelly JP Naldi L et al.Medication use and the risk of Stevens-Johnson syndrome or toxic epiderma necrolysis.N EnglJ Med. 1995; 333: 1600-1607Crossref PubMed Scopus (1216) Google Scholar All cases occurred in the first 8 weeks of treatment. Our results therefore support Rzany and colleagues' conclusions on lamotrigine. A notable feature of our study, however, was that 42% (five of 12) of cases were in children younger than 12 years. The estimated incidence of SJS in this age-group was 0·34, compared with 0·08/1000 patient-months of treatment in people older than 12 years (relative risk 4·11 [95% CI 1·30–12·95]). The incidence of SJS normally peaks between ages 20 years and 40 years. All the children with confirmed SJS were also taking sodium valproate, which doubles the half-life of lamotrigine.4Summary of Product Characteristics. Lamictal.ABPI compendium of data sheets and summary of product characteristics, 1999–2000. Datapharm Publications Ltd, London1999Google Scholar Thus, that neither short-term nor long-term use of valproic acid seems to increase the risk of SJS may be true if it refers only to monotherapy, but sodium valproate could be implicated in the cause of this disorder when lamotrigine is used as add-on therapy, as is common in children." @default.
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• W2083008384 date "1999-09-01" @default.
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• W2083008384 title "Stevens-Johnson syndrome and antiepileptics" @default.
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