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Sancetta BM, Ricci L, Lanzone J, Boscarino M, Narducci F, Lippa G, Nesta M, Di Lazzaro V, Tombini M, Assenza G. Overnight switch from carbamazepine to eslicarbazepine in a real-life clinical scenario: a retrospective study. Neurol Sci 2024; 45:3435-3442. [PMID: 38315252 DOI: 10.1007/s10072-024-07354-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/22/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Carbamazepine (CBZ) is a first-choice anti-seizure medication (ASM) whose efficacy is often invalidated by adverse effects (AEs). Eslicarbazepine (ESL) is a structural derivative of CBZ with better pharmacokinetic/tolerability profiles. We describe our experience of the overnight CBZ to ESL switch in people with epilepsy (PwE) to improve seizure control, AEs, and ASMs adherence. METHODS We retrospectively included 19 PwE (12 females, 53 ± 21 years old) who underwent CBZ to ESL overnight switch due to single/multiple issues: poor efficacy (pEff, N = 8, 42%), tolerability (pToll, N = 11, 58%), adherence (pAdh, N = 2, 10%). 9/19 (47%) had psychiatric comorbidities. Clinical variables, seizure frequency, and AEs were recorded at switch time (T0) after 3.5 ± 3 (T1) and 6.5 ± 1.5 months (T2). RESULTS At T1, in pEff group, 1/8 (13%) was seizure free, 2/8 (25%) were responders (> 50% seizure reduction), 2/8 (25%) had no seizure changes, 3/8 (37%) had seizure worsening; the latter were those with the most severe epilepsy and encephalopathy. In pToll group, all PwE experienced AEs disappearance/amelioration. In pAdh group, all PwE reported adherence amelioration. Four dropouts. At T2, no changes were recorded within groups, while in the whole sample, 6/15 (40%) were responders, and 4/15 (27%) were seizure-free. No one complained of Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation psychiatric worsening, while 6/19 (32%) experienced mood/behavior benefits. CONCLUSIONS CBZ to ESL overnight switch offers an opportunity to improve efficacy, tolerability, adherence, and psychiatric symptoms.
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Affiliation(s)
- Biagio Maria Sancetta
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
- Research Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
| | - Lorenzo Ricci
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Jacopo Lanzone
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
| | - Marilisa Boscarino
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
| | - Flavia Narducci
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Giulia Lippa
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Marianna Nesta
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Vincenzo Di Lazzaro
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Mario Tombini
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Giovanni Assenza
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
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Stancil SL, Sandritter T, Strawn JR. Pharmacogenetics and Oxcarbazepine in Children and Adolescents: Beyond HLA-B*15:02. J Child Adolesc Psychopharmacol 2024; 34:61-66. [PMID: 38377523 PMCID: PMC10880270 DOI: 10.1089/cap.2023.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Background: Oxcarbazepine is thought to be better-tolerated and less susceptible to drug-drug interactions than its predecessor, carbamazepine. Genetic testing for HLA-B*15:02 is recommended in specific populations to identify those at high risk of severe hypersensitivity reactions; however, other pharmacologic and pharmacogenetic factors that can impact drug disposition may be involved. Methods: We present a case of an 8-year-old boy treated with oxcarbazepine who developed drug reaction with eosinophilia and systemic symptoms (DRESS) with Stevens-Johnsons syndrome overlap and was negative for HLA-B*15:02. We review the extant literature related to oxcarbazepine disposition, and potential pharmacogenetic variants in aldoketoreductase 1C (AKR1C)2-4 that may contribute to this risk. Results: Genetic variability in oxcarbazepine disposition pathways may contribute to tolerability and toxicity, including the development of hypersensitivity reactions. Conclusions: While preemptive genetic testing for HLA-B*15:02 in individuals of Asian ancestry is recommended to prevent severe hypersensitivity reactions to oxcarbazepine, oxcarbazepine concentrations and AKR1C variation may contribute to the risk of severe adverse reactions. We provide recommendations for future study to elucidate whether these individual factors are important for reducing the risk of severe adverse events.
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Affiliation(s)
- Stephani L. Stancil
- Division of Adolescent Medicine, Children's Mercy Kansas City, Kansas City, Missouri, USA
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy Kansas City, Kansas City, Missouri, USA
- Department of Pediatrics, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Tracy Sandritter
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Jeffrey R. Strawn
- Department of Psychiatry and Behavioral Neuroscience and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Mehta D, Davis M, Epstein AJ, Wensel B, Grinnell T, Williams GR. Comparative Economic Outcomes in Patients with Focal Seizure Initiating First-Line Eslicarbazepine Acetate Monotherapy versus Generic Antiseizure Drugs. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:251-261. [PMID: 33907433 PMCID: PMC8064618 DOI: 10.2147/ceor.s303079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/12/2021] [Indexed: 01/12/2023] Open
Abstract
Objective To examine the association between initiating first-line (1L) monotherapy with eslicarbazepine acetate (ESL) vs a generic antiseizure drug (ASD) and healthcare resource utilization (HCRU) and charges in adults with treated focal seizures (FS). Methods This was a retrospective analysis of Symphony Health’s Integrated Dataverse® open-source claims data. Two cohorts were identified as having initiated 1L monotherapy with ESL or literature-defined generic ASDs. Linear regression models with person fixed effects and inverse probability treatment weights assessed the relative additional changes in HCRU and charges among patients who received ESL compared to generic ASD. Results A total of 250 and 43,220 patients initiated ESL (48.3 years; 57.2% female) or a generic ASD (54.5 years; 58.1% female), respectively. Compared to patients initiating a generic ASD, patients treated with ESL had additional reductions of 11.8 percentage points in the likelihood of any all-cause outpatient visits (P<0.001), 7.4 percentage points in the likelihood of any emergency department (ED) visits (P=0.013), and 22.7 percentage points in the likelihood of any FS-related outpatient visits (P<0.001). Patients initiating ESL had greater reductions in mean charges for all-cause medical ($2620; P=0.002), outpatient ($1995; P=0.005), and non-FS-related medical ($2708; P<0.001) services. Patients initiating ESL had greater relative increases in mean total prescription ($1368; P<0.001) and ASD-related prescription ($1636; P<0.001) charges, but greater relative reductions in non-ASD prescription ($269; P=0.032) charges. The increases in prescription charges were of a lower magnitude than the decreases in medical charges. Conclusion Initiation of ESL as 1L monotherapy was associated with statistically significantly greater reductions in any use of several all-cause and FS-related services, number of visits, and charges compared to initiation of a generic ASD as 1L monotherapy in patients with FS. Initiation of a generic ASD as 1L monotherapy was associated with significantly smaller increases in total prescription charges and ASD-related prescription charges.
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Affiliation(s)
| | | | | | - Brian Wensel
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | - Todd Grinnell
- Medical Affairs, Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
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Healthcare Resource Utilization Among Patients with Focal Seizures Treated with Eslicarbazepine Acetate in the US Long-Term Care Setting: A Retrospective Claims Database Analysis. Neurol Ther 2021; 10:673-691. [PMID: 33826104 PMCID: PMC8571427 DOI: 10.1007/s40120-021-00244-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction The aim of this study was to compare healthcare resource utilization (HCRU) before and after initiation of eslicarbazepine acetate (ESL) in the long-term care (LTC) setting (rehabilitation center, mental health center, LTC non-skilled nursing facility/assisted-living facility, home health, assisted living, nursing home, other/unknown). Methods This retrospective analysis used IQVIA’s New Data Warehouse, which includes deterministically linked LTC, prescription, and professional fee claims data and IQVIA Hospital Charge Data Master database. The study period was 1 April 2013 to 31 December 2019. The index date was the date of ESL initiation in the LTC setting. Inclusion criteria were: (1) ≥ 1 new ESL prescription between 1 April 2014 and 31 December 2018; (2) diagnosis of focal seizure (FS) during the 12 months pre-index date; and (3) no ESL prescription during the 12-month period pre-index. A 12-month pre-post analysis compared epilepsy-specific and all-cause HCRU before and after ESL initiation. Categorical variables were compared with McNemar’s tests. Results A total of 307 patients (mean age 52.2 years, 57.7% male) with FS were included, of whom 24.8% were in nursing homes. Patients used a mean of 3.1 antiseizure drugs prior to initiation of ESL, and 87.9% of patients initiated ESL as adjunctive treatment. There were significant reductions in proportion of patients with epilepsy specific physician office visits, emergency department (ED) visits, hospitalizations, and all-cause physician office visits and hospitalizations in the post-index period compared to the pre-index period (P < 0.05). Similar results were observed in sensitivity (patients with an epilepsy diagnosis) and subgroup analyses [presence or absence of intellectual developmental disorders or age (≥ 65 and < 65 years)]. Conclusion Proportion of patients with epilepsy-specific physician office visits, ED visits, hospitalizations, and all-cause physician office visits and hospitalizations were significantly reduced following initiation of ESL in patients with FS in LTC. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-021-00244-5.
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Mehta D, Davis M, Epstein AJ, Wensel B, Grinnell T, Thach A, Williams GR. Comparative economic outcomes in patients with focal seizures initiating eslicarbazepine acetate versus brivaracetam as their first adjunctive ASD. J Med Econ 2021; 24:939-948. [PMID: 34311671 DOI: 10.1080/13696998.2021.1960682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS To study the association between initiation of first adjunctive therapy with eslicarbazepine acetate (ESL) vs. brivaracetam (BRV) on healthcare resource utilization (HCRU) and charges among patients with treated focal seizures (FS). MATERIALS AND METHODS Symphony Health's Integrated Dataverse (IDV) claims data (1 April 2015 to 30 June 2018) were used to identify two cohorts as first adjunctive therapy with ESL or BRV following a generic anti-seizure drug (ASD). The index date was the earliest claim for a new ESL or BRV prescription. Key inclusion criteria were only 1 generic ASD in the 12 months before the index date; ≥1 medical claim with an FS diagnosis. Unit of analysis was the 90-day person-time-block. Changes in HCRU and charges were assessed using a difference-in-differences framework. Both unadjusted and adjusted analyses were performed. The adjusted model utilized person-specific fixed effects and propensity score-based weighting to control for differences in baseline covariates. Bias-corrected bootstrap confidence intervals (CIs) were calculated for charge outcomes. RESULTS 208 and 137 patients initiated first adjunctive therapy with ESL (43.7 years, 51.9% female) or BRV (39.3 years, 51.8% female). Patients in the ESL cohort had numerically larger reductions in all-cause and FS-related inpatient hospitalizations and outpatient visits and FS-related emergency department visits. Compared to patients initiating BRV, patients treated with ESL had significantly larger reductions in total charges (-$3,446, CI: -$13,716, -$425), all-cause (-$3,166, CI: -$13,991, -$323) and FS-related (-$2,969, CI: -$21,547, -$842) medical charges, all-cause (-$3,397, CI: -$15,676, -$818) and FS-related (-$2,863, CI: -$19,707, -$787) outpatient charges, and non-ASD-related prescription charges (-$420, CI: -$1,058, -$78). LIMITATIONS Claims may be missing, or miscoded; outcomes may be influenced by variables not accounted for in the analysis; only information on submitted charges was included. CONCLUSIONS Among patients with FS, initiation of first adjunctive therapy with ESL was associated with significantly larger reductions in medical and non-ASD-related prescriptions charges compared to BRV.
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Affiliation(s)
| | | | | | - Brian Wensel
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | | | - Andrew Thach
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
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Rohracher A, Kalss G, Kuchukhidze G, Neuray C, Leitinger M, Höfler J, Kreidenhuber R, Rossini F, Volna K, Mauritz M, Poppert N, Lattanzi S, Brigo F, Trinka E. New anti-seizure medication for elderly epilepsy patients - a critical narrative review. Expert Opin Pharmacother 2020; 22:621-634. [PMID: 33111598 DOI: 10.1080/14656566.2020.1843636] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction: The number of elderly patients with epilepsy is growing in resource rich countries due to demographic changes and increased longevity. Management in these patients is challenging as underlying etiology, co-morbidities, polypharmacy, age-related pharmacokinetic and pharmacodynamic changes need to be considered.Areas covered: Lacosamide, eslicarbazepine acetate, brivaracetam, and perampanel have been approved in the USA and Europe for monotherapy and/or adjunctive treatment of seizures in the last few years. The authors review the pharmacological properties and safety profile of these drugs and provide recommendations for their use in in the elderly.Expert opinion: There are only limited data available on more recent antiseizure medications (ASMs). Drugs with a low risk of interaction (lacosamide, brivaracetam) are preferred choices. Once daily formulations (perampanel and eslicarbazepine acetate) have the advantage of increased compliance. Intravenous formulations (brivaracetam and lacosamide) are useful in emergency situations and in patients who have difficulties to swallow. Dose adjustments are necessary for all ASMs used in the elderly with slow titration and lower target doses than in the regulatory trials. The adverse event profile does not significantly differ from that found in the general adult population.
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Affiliation(s)
- A Rohracher
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, affiliated partner of the ERN EpiCARE Center for Cognitive Neuroscience, Paracelsus Medical University Salzburg, and Christian Doppler Medical Centre, Salzburg, Austria
| | - G Kalss
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, affiliated partner of the ERN EpiCARE Center for Cognitive Neuroscience, Paracelsus Medical University Salzburg, and Christian Doppler Medical Centre, Salzburg, Austria
| | - G Kuchukhidze
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, affiliated partner of the ERN EpiCARE Center for Cognitive Neuroscience, Paracelsus Medical University Salzburg, and Christian Doppler Medical Centre, Salzburg, Austria
| | - C Neuray
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, affiliated partner of the ERN EpiCARE Center for Cognitive Neuroscience, Paracelsus Medical University Salzburg, and Christian Doppler Medical Centre, Salzburg, Austria
| | - M Leitinger
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, affiliated partner of the ERN EpiCARE Center for Cognitive Neuroscience, Paracelsus Medical University Salzburg, and Christian Doppler Medical Centre, Salzburg, Austria
| | - J Höfler
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, affiliated partner of the ERN EpiCARE Center for Cognitive Neuroscience, Paracelsus Medical University Salzburg, and Christian Doppler Medical Centre, Salzburg, Austria
| | - R Kreidenhuber
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, affiliated partner of the ERN EpiCARE Center for Cognitive Neuroscience, Paracelsus Medical University Salzburg, and Christian Doppler Medical Centre, Salzburg, Austria
| | - F Rossini
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, affiliated partner of the ERN EpiCARE Center for Cognitive Neuroscience, Paracelsus Medical University Salzburg, and Christian Doppler Medical Centre, Salzburg, Austria
| | - K Volna
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, affiliated partner of the ERN EpiCARE Center for Cognitive Neuroscience, Paracelsus Medical University Salzburg, and Christian Doppler Medical Centre, Salzburg, Austria
| | - M Mauritz
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, affiliated partner of the ERN EpiCARE Center for Cognitive Neuroscience, Paracelsus Medical University Salzburg, and Christian Doppler Medical Centre, Salzburg, Austria
| | - N Poppert
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, affiliated partner of the ERN EpiCARE Center for Cognitive Neuroscience, Paracelsus Medical University Salzburg, and Christian Doppler Medical Centre, Salzburg, Austria
| | - S Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - F Brigo
- Department of Neurology, Franz Tappeiner Hospital, Meran, Italy
| | - E Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, affiliated partner of the ERN EpiCARE Center for Cognitive Neuroscience, Paracelsus Medical University Salzburg, and Christian Doppler Medical Centre, Salzburg, Austria
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Watkins L, O'Dwyer M, Oak K, Lawthom C, Maguire M, Thomas R, Shankar R. The evidence for switching dibenzazepines in people with epilepsy. Acta Neurol Scand 2020; 142:121-130. [PMID: 32249420 DOI: 10.1111/ane.13248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/21/2020] [Accepted: 03/27/2020] [Indexed: 01/06/2023]
Abstract
The dibenzazepines particularly carbamazepine are associated with known adverse effects (AEs) and drug to drug interactions. Eslicarbazepine acetate (ESL) is structurally distinct from other members of the dibenzazepine family and has the advantage of once daily dosing. Observational and trial data report successful switching from older dibenzazepines to ESL. The evidence base for doing so is unclear and not standardized. This is a literature review following the PRISMA scoping guidelines identifying the evidence of switching dibenzazepines. Transition methods, ratios, tolerance to change, adverse effects and retention post-change were evaluated. Study quality was assessed using the Oxford Centre for Evidence Based Medicine levels of evidence. Seven studies investigated the outcome of transition between carbamazepine and or oxcarbazepine to ESL, with specific data on the transition dose ratio and scheduling. The available data suggest that the overnight transition between oxcarbazepine and ESL in a 1:1 ratio (most common) is generally well tolerated with high retention rates. The transition showed improvement in adverse events associated with oxcarbazepine across a variety of domains. Almost 60% transitioned because of adverse events experienced no further symptoms at 12 months. There is less data on the transition from carbamazepine to ESL. The evidence available suggests an overnight transition in the ratio of 1:1.3-1.5. The retention rate following transition from carbamazepine to ESL was 69% (follow-up of 4 months) with almost half of those transitioned because of adverse events experiencing no further symptoms. There is Grade C evidence available to help guide clinicians in the transition.
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Affiliation(s)
| | - Marie O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences Trinity College Dublin Ireland
| | - Katy Oak
- Royal Cornwall Hospital Trust Truro UK
| | - Charlotte Lawthom
- Aneurin Bevan University Health Board Newport UK
- Swansea University Swansea UK
| | - Melissa Maguire
- Leeds General Infirmary Leeds UK
- Leeds Institute of Biomedical & Clinical Sciences University of Leeds Leeds UK
| | - Rhys Thomas
- Institute of Neuroscience Newcastle University Newcastle‐upon‐Tyne UK
- Royal Victoria Infirmary Newcastle‐upon‐Tyne UK
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust Threemilestone Industrial Estate Truro UK
- University of Exeter Medical School Knowledge Spa Truro UK
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Doherty CP, Rheims S, Assenza G, Boero G, Chaves J, McMurray R, Villanueva V. Eslicarbazepine acetate in epilepsy patients with psychiatric comorbidities and intellectual disability: Clinical practice findings from the Euro-Esli study. J Neurol Sci 2019; 402:88-99. [DOI: 10.1016/j.jns.2019.04.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/05/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
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de Biase S, Nilo A, Bernardini A, Gigli GL, Valente M, Merlino G. Timing use of novel anti-epileptic drugs: is earlier better? Expert Rev Neurother 2019; 19:945-954. [DOI: 10.1080/14737175.2019.1636649] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Stefano de Biase
- Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
| | - Annacarmen Nilo
- Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
| | - Andrea Bernardini
- Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
| | - Gian Luigi Gigli
- Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
- DMIF, University of Udine, Udine, Italy
| | - Mariarosaria Valente
- Neurology Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine Medical School, Udine, Italy
| | - Giovanni Merlino
- Stroke Unit, Department of Neurosciences, University Hospital of Udine, Udine, Italy
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Abstract
Carbamazepine (CBZ), oxcarbazepine (OXC), and eslicarbazepine acetate (ESL) belong to the dibenzazepine family of antiepileptic drugs and are all thought to primarily act as sodium channel blockers (SCBs). However, ESL is structurally distinct from CBZ and OXC, resulting in differences in metabolism, pharmacokinetics, and pharmacodynamics. Despite a lack of direct comparative data, evidence for potential differences in effectiveness and tolerability within the dibenzazepine family has emerged from studies in which patients being treated with one dibenzazepine agent have received adjunctive treatment with another (having achieved insufficient seizure control with the first) or have transitioned from one dibenzazepine agent to another because of lack of effectiveness or poor tolerability. Most of these studies have been conducted in the real-world clinical practice setting. ESL has been shown to be effective as adjunctive therapy in patients who have previously achieved inadequate seizure control with CBZ, indicating that the use of different dibenzazepine agents in combination can provide additive effectiveness benefits, which may reflect underlying differences in their mechanisms of action. Similarly, ESL monotherapy can be effective in patients who have switched from another dibenzazepine, such as CBZ or OXC, because of inadequate efficacy. There is also considerable evidence to demonstrate that patients transitioning from OXC or CBZ to ESL as a result of adverse events experience improvements in tolerability, which may also be associated with improvements in quality of life, alertness, and/or lipid profiles. Current evidence therefore demonstrates that ESL differs from other dibenzazepine agents in terms of effectiveness and tolerability. Funding: Eisai Ltd.
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Lattanzi S, Brigo F, Cagnetti C, Verrotti A, Zaccara G, Silvestrini M. Eslicarbazepine acetate in the treatment of adults with partial-onset epilepsy: an evidence-based review of efficacy, safety and place in therapy. CORE EVIDENCE 2018; 13:21-31. [PMID: 29563858 PMCID: PMC5846310 DOI: 10.2147/ce.s142858] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Up to 30% of the patients diagnosed with epilepsy will continue suffering from seizures despite treatment with antiepileptic drugs, either in monotherapy or polytherapy. Hence, there remains the need to develop new effective and well-tolerated therapies. AIM The objective of this article was to review the evidence for the efficacy and safety of eslicarbazepine acetate (ESL) as adjunctive treatment in adult patients with focal onset seizures. EVIDENCE REVIEW ESL is the newest, third-generation, single enantiomer member of the dibenzazepine family. Following oral administration, ESL is rapidly and extensively metabolized by hepatic first-pass hydrolysis to the active metabolite eslicarbazepine, which has linear, dose-proportional pharmacokinetics and low potential for drug-drug interactions. Eslicarbazepine works as a competitive blocker of the voltage gated sodium channels; unlike carbamazepine (CBZ) and oxcarbazepine (OXC), it has a lower affinity for the resting state of the channels, and reduces their availability by selectively enhancing slow inactivation. Efficacy and safety of ESL have been assessed in four randomized, Phase III clinical trials: the median relative reduction in standardized seizure frequency was 33.4% and 37.8% in the ESL 800 and 1,200 mg daily dose groups, and the responder rates were 33.8% and 43.1%, respectively. The incidence of treatment-emergent adverse events (TEAEs) increased with raising the dosage (ESL 400 mg: 63.8%, ESL 800 mg: 67.0%, ESL 1,200 mg: 73.1%). The TEAEs were generally mild to moderate in intensity, and the most common were dizziness, somnolence, headache and nausea. Open-label studies confirmed the findings from the pivotal trials and demonstrated sustained therapeutic effect of ESL over time and improvement of tolerability profile in patients switching from OXC/CBZ. No unexpected safety signals emerged over >5 years of follow-up. CONCLUSION Once-daily adjunctive ESL at the doses of 800 and 1,200 mg was effective to reduce the seizure frequency and was fairly well tolerated in adults with focal onset epilepsy. Starting treatment at 400 mg/day, followed by 400 mg increments every 7-14 days, could provide the optimal balance of efficacy and tolerability.
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Affiliation(s)
- Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Via Conca, Ancona, Italy
| | - Francesco Brigo
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Italy
- Division of Neurology, “Franz Tappeiner” Hospital, Merano BZ, Italy
| | - Claudia Cagnetti
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Via Conca, Ancona, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L’Aquila, L’Aquila, Italy
| | - Gaetano Zaccara
- Unit of Neurology, Department of Medicine, Usl Centro Toscana Health Authority, Firenze, Italy
| | - Mauro Silvestrini
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Via Conca, Ancona, Italy
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Willems LM, Zöllner JP, Paule E, Schubert-Bast S, Rosenow F, Strzelczyk A. Eslicarbazepine acetate in epilepsies with focal and secondary generalised seizures: systematic review of current evidence. Expert Rev Clin Pharmacol 2017; 11:309-324. [PMID: 29285947 DOI: 10.1080/17512433.2018.1421066] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Eslicarbazepine acetate (ESL) is a third-generation antiepileptic drug (AED) approved for adjunctive treatment in adults, children, and adolescents with focal-onset seizures. Recently ESL was approved for initial monotherapy in adults. The intention of this article is to review current evidence for ESL and to summarise its pharmacological profile in comparison to other AEDs of the dibenzazepine group. Areas covered: We performed a systematic literature search in electronic databases (MEDLINE database, Cochrane Central Register of Controlled Trials, Excerpta Medica dataBASE) using a combined search strategy including the following keywords: eslicarbazepine, epilepsy and seizure. The search was performed from 2000 until December 2017. Using a standardised assessment form, information on the study design, methodological framework, data sources and efficacy and adverse events attributed to ESL were extracted from each publication and systematically reported. Expert commentary: ESL is an effective, safe and well tolerated third-generation AED for the treatment of focal epilepsies. During therapy, especially serum sodium levels and possible interactions with other substances have to be monitored. As of yet, long-term experience is still needed to make severe late-occurring adverse events unlikely and to obtain data regarding its use in pregnancy.
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Affiliation(s)
- Laurent M Willems
- a Epilepsy Center Frankfurt Rhine-Main and Department of Neurology , Goethe-University , Frankfurt am Main , Germany
| | - Johann Philipp Zöllner
- a Epilepsy Center Frankfurt Rhine-Main and Department of Neurology , Goethe-University , Frankfurt am Main , Germany
| | - Esther Paule
- a Epilepsy Center Frankfurt Rhine-Main and Department of Neurology , Goethe-University , Frankfurt am Main , Germany
| | - Susanne Schubert-Bast
- a Epilepsy Center Frankfurt Rhine-Main and Department of Neurology , Goethe-University , Frankfurt am Main , Germany.,c Department of Neuropediatrics , Goethe-University , Frankfurt am Main , Germany
| | - Felix Rosenow
- a Epilepsy Center Frankfurt Rhine-Main and Department of Neurology , Goethe-University , Frankfurt am Main , Germany.,b Epilepsy Center Hessen and Department of Neurology , Philipps-University , Marburg , Germany
| | - Adam Strzelczyk
- a Epilepsy Center Frankfurt Rhine-Main and Department of Neurology , Goethe-University , Frankfurt am Main , Germany.,b Epilepsy Center Hessen and Department of Neurology , Philipps-University , Marburg , Germany
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Elger C, Koepp M, Trinka E, Villanueva V, Chaves J, Ben-Menachen E, Kowacs PA, Gil-Nagel A, Moreira J, Gama H, Rocha JF, Soares-da-Silva P. Pooled efficacy and safety of eslicarbazepine acetate as add-on treatment in patients with focal-onset seizures: Data from four double-blind placebo-controlled pivotal phase III clinical studies. CNS Neurosci Ther 2017; 23:961-972. [PMID: 29030894 PMCID: PMC5813188 DOI: 10.1111/cns.12765] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 11/28/2022] Open
Abstract
Purpose Pooled evaluation of the key efficacy and safety profile of eslicarbazepine acetate (ESL) added‐on to stable antiepileptic therapy in adults with focal‐onset seizures. Methods Data from 1703 patients enrolled in four phase III double‐blind, randomized, placebo‐controlled studies were pooled and analyzed. Following a 2 week titration period, ESL was administered at 400 mg, 800 mg, and 1200 mg once‐daily doses for 12 weeks (maintenance period). Pooled efficacy variable was standardized (/4 weeks) seizure frequency (SSF) analyzed over the maintenance period as reduction in absolute and relative SSF and proportion of responders (≥50% reduction in SSF). Pooled safety was analyzed by means of adverse events and clinical laboratory assessments. Results SSF was significantly reduced with ESL 800 mg (P < 0.0001) and 1200 mg (P < 0.0001) compared to placebo. Median relative reduction in SSF was 33.4% for ESL 800 mg and 37.8% for 1200 mg (placebo: 17.6%), and responder rate was 33.8% and 43.1% (placebo: 22.2%). ESL was more efficacious than placebo regardless of gender, geographical region, epilepsy duration, age at time of diagnosis, seizure type, and type of concomitant antiepileptic drugs (AED). Incidence of adverse events (AEs) and AEs leading to discontinuation was dose dependent. Most common AEs (>10% patients) were dizziness, somnolence, and nausea. The incidence of treatment‐emergent AEs (dizziness, somnolence, ataxia, vomiting, and nausea) was lower in patients who began taking ESL 400 mg (followed by 400 mg increments to 800 or 1200 mg) than in those who began taking ESL 600 mg or 800 mg. Conclusions Once‐daily ESL 800 mg and 1200 mg showed consistent results across all efficacy and safety endpoints, independent of study population characteristics and type of concomitant AEDs. Treatment initiated with ESL 400 mg followed by 400 mg increments to 800 or 1200 mg provides optimal balance of efficacy and tolerability.
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Affiliation(s)
- Christian Elger
- Department of Epileptology, University of Bonn, Bonn, Germany
| | - Mathias Koepp
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, London, UK
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
| | - Vicente Villanueva
- Unidad Multidisciplinar de Epilepsia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - João Chaves
- Serviço de Neurologia, Hospital S. António, Centro Hospitalar do Porto, Porto, Portugal
| | - Elinor Ben-Menachen
- Department of Clinical Neuroscience and Physiology, Sahlgren Academy, Sahlgren University Hospital, Göteborg, Sweden
| | | | | | - Joana Moreira
- Department of Research and Development, BIAL - Portela & Cª, S.A., S. Mamede do Coronado, Portugal
| | - Helena Gama
- Department of Research and Development, BIAL - Portela & Cª, S.A., S. Mamede do Coronado, Portugal
| | - José-Francisco Rocha
- Department of Research and Development, BIAL - Portela & Cª, S.A., S. Mamede do Coronado, Portugal
| | - Patrício Soares-da-Silva
- Department of Research and Development, BIAL - Portela & Cª, S.A., S. Mamede do Coronado, Portugal.,Department of Biomedicine, Faculty of Medicine, Unit of Pharmacology and Therapeutics, University of Porto, Porto, Portugal.,MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
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Mäkinen J, Rainesalo S, Peltola J. Transition from oxcarbazepine to eslicarbazepine acetate: A single center study. Brain Behav 2017; 7:e00634. [PMID: 28293474 PMCID: PMC5346521 DOI: 10.1002/brb3.634] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 12/12/2016] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES There is limited clinical evidence for comparison between oxcarbazepine (OXC) and eslicarbazepine acetate (ESL) in terms of tolerability, or how to execute the change from OXC to ESL. We report the process of transitioning patients with focal epilepsy from previous OXC treatment to ESL due to tolerability problems. The rationale for change from OXC is reported, and the outcome with respective to this rationale is analyzed in terms of tolerability and efficacy. MATERIALS AND METHODS The subjects were transitioned overnight from OXC to ESL in a hospital inpatient setting. An evaluation of the effects of the transition was made after 1 and 3 months. All adverse events (AEs) were recorded following the transition period. Subjects were classified by outcome in terms of AEs. RESULTS Twenty-three subjects were transitioned from OXC to ESL. Fifteen patients OXC-related AEs reduced significantly after transition. Particularly, most of (93%) the AEs presented in the morning resolved after transition to ESL. No patient had an increase in seizure frequency following the transition. The incidence of ESL-related AEs was 39% at 1 month and 13% at 3 month follow-up; however, all patients continued ESL throughout the study period. CONCLUSIONS This study demonstrates that patients suffering from OXC-related AEs improve in terms of tolerability after a switch to ESL with maintaining seizure control. This improvement is more pronounced if the OXC-related AEs are most evident following morning dosing of OXC. Transition can be safely executed in an outpatient setting.
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Affiliation(s)
- Jussi Mäkinen
- Department of Neurology Tampere University Hospital Tampere Finland
| | - Sirpa Rainesalo
- Department of Neurology Tampere University Hospital Tampere Finland
| | - Jukka Peltola
- Department of Neurology University of Tampere and Tampere University Hospital Tampere Finland
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