Comparison of Efficacy and Adverse Effects of Natural and Synthetic Adrenocorticotrophin in Treatment of Epileptic Spasms.
Abstract number :
1.168
Submission category :
Year :
2001
Submission ID :
3007
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
M. Demos, MD, Pediatric Neurology, University of British Columbia, Vancouver, BC, Canada; P. Gerber, Pharm D, Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada; K. Farrell, MB, Pediatric Neurology, University of British Columb
RATIONALE: Natural and synthetic formulations of adrenocorticotrophic hormone (ACTH)possess different chemical characteristics. Natural ACTH is no longer marketed in Canada and patients at our centre now receive synthetic ACTH. We compared the efficacy and adverse effects in children with epileptic spasms.
METHODS: This retrospective study compared 17 children with spasms, who received synthetic ACTH, with a historical control group of the previous 16 children, who had received natural ACTH. The hospital charts were reviewed.
RESULTS: The mean maximum dose of ACTH was 69 IU (40 - 120) in the 16 children receiving natural ACTH and 45 IU (30 - 60) in those receiving synthetic ACTH. Epileptic spasms were controlled in 9 of 16 on natural ACTH and 11 of 17 on synthetic ACTH. In the patients admitted for ward observation (13 on natural and 14 on synthetic ACTH), the most common adverse effects (natural v synthetic)were irritability (12 v 13), hypertension (11 v 5) and electrolyte disturbance (8 v 4). ACTH was discontinued because of adverse effects alone in 7 patients receiving synthetic ACTH (possible sepsis 2, hypertension 2, gastrointestinal bleed 2, irritability 1) and in 1 on natural ACTH (hypertension/cardiomyopathy). ACTH was discontinued because of a combination of adverse effects and lack of efficacy in 2 (natural) and 3 (synthetic).
CONCLUSIONS: Natural and synthetic ACTH appeared to be equally effective in controlling epileptic spasms. Although hypertension and electrolyte disturbance tended to occur more often during initiation of treatment in those receiving natural ACTH, ACTH was discontinued more often for adverse effects in those receiving synthetic ACTH.