内科-神经内癫痫治疗指南新看点.ppt

* * * * * * 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 1.评估标准不统一 2.缺乏证据≠不存在的证据 3.时间局限性→过时、更新 4.受到药厂的影响，有一定的利益因素 5.由少部分专家制定 6.个体差异 7.临床医生执行时困难 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 发布机构 发布年限 苏格兰临床指导协作组(SIGN) 2003 英国临床优化研究所 （NICE） 2004 美国神经学会（AAN） 美国癫痫学会（AES） 2004 ILAE 2006 Payakachat et al. J Manag Care Pharma 2006 ??Welcome to the National Institute for Health????????????????????and Clinical Excellence website ??????NICE is the independent organization 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 becomethe 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’. (.uk/) 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: .uk/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: .uk/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. A