CONy 2022 | Abandoning the use of enzyme-inducing antiepileptic drugs
Ley Sander, MD, PhD, FRCP, FEAN, UCL Queen Square Institute of Neurology, London, UK, provides his perspectives on prescribing enzyme-inducing antiepileptic medications, which can have numerous side effects. Enzyme inhibiting drugs may damage the liver and alter the levels of endogenous enzymes, leading to an increased risk of osteoporosis, sexual dysfunction, cardio- and cerebrovascular disease. Despite the side effects, enzyme inhibiting drugs are cost-effective and short-term exposure may be beneficial for patients. This interview was conducted during the 2022 World Congress on Controversies in Neurology (CONy) meeting.
Transcript (edited for clarity)
The reason why enzyme inducers, they can cause damage to people that we are treating. I think that to put it on a very nutshell, these drugs, they make liver work overtime, and by making the liver work overtime, they actually increase the clearance of a number of other drugs, but most importantly of endogenous enzyme systems that we need to work well. For instance, it will lead to hormonal changes that will affect the bone health...
The reason why enzyme inducers, they can cause damage to people that we are treating. I think that to put it on a very nutshell, these drugs, they make liver work overtime, and by making the liver work overtime, they actually increase the clearance of a number of other drugs, but most importantly of endogenous enzyme systems that we need to work well. For instance, it will lead to hormonal changes that will affect the bone health. And therefore people that take these drugs on the long term, they might be at risk of osteoporosis and pathological fractures. It may affect sexual function by increasing the clearance of sexual hormones of the body, leading for instance, in male erectile dysfunction, and can also cause problems for women. It’s well known that people that have, for instance, chemotherapy for cancer, their survival is less ideal compared to people not on enzyme inducers. There is just some of the issues around it. And then we have probably the most important problem, is that they increase the potential for cerebral vascular disease and cardiovascular disease. And therefore they may be causing comorbidities and taking years off people life expectancy.
We don’t have the clear evidence, but all the circumstantial evidence coming together seems to be consistent that there is a problem with this class of drugs. In favor of them, is that you could argue that they are very cheap. And sometimes this is the only drug that some of the people we look after with epilepsy, particularly in resource poor settings will be able to afford. Now, I think that the problem with these drugs is when they have to be taken for long periods of time. You could argue that maybe if you, seeing that someone will only need a short period of treatment, a few years, you might be in a stronger wicket than if you say, I know that this patient will have to take such drugs for the rest of their life. I think it’s always a dilemma, but I myself, I know as a fact that I would not use enzyme inducers if I were to treat myself or someone in my family.
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Disclosures
Prof. Sander received research grants from UCB Pharma; Received honoraria or consultation fees from Angellini, Eisai and UCB; Participated in a company sponsored speaker’s bureau: Angellini, GW, Zogenix and Eisai.
