Can Generic Intravenous Levetiracetam Be Used for Acute Repetitive Convulsive Seizure or Status Epilepticus? A Randomized Controlled Trial

Efficacy of a pre-specified timeline-based treatment protocol in children with acute repetitive seizures or seizure clusters

Objectives

Acute repetitive seizures (ARSs) are one of the few commonly encountered neurological emergencies in children. There is a need for an appropriate timeline-based treatment protocol, which will be shown to be safe and efficacious in a clinical study.

Materials and Methods

This was a retrospective chart review to determine the efficacy of a pre-specified treatment protocol for the management of ARSs in children aged 1-18 years. The treatment protocol was specifically applied in children with a diagnosis of epilepsy and not critically ill, who met the criteria for ARSs, with the exemption of new onset of ARSs. The first tier of treatment protocol focused on intravenous lorazepam, optimization of dose of existing anti-seizure medications (ASMs), and control of triggers like acute febrile illness, while second-tier focused on adding one or two additional ASMs, commonly used in cases with seizure clusters or status epilepticus.

Results

We included the first 100 consecutive patients (7.6 ± 3.2 years, 63% boys). Our treatment protocol was successful in 89 patients (58 and 31 required first-tier and second-tier treatment). The absence of pre-existing drug-resistant epilepsy and the presence of acute febrile illness as a triggering factor (P = 0.02 and 0.03) were associated with the success of the first tier of the treatment protocol. Excessive sedation (n = 29), incoordination (n = 14), transient gait instability (n = 11), and excessive irritability (n = 5) were the most common adverse effects observed during the initial 1 week.

Conclusion

This pre-specified treatment protocol is safe and efficacious in controlling ARSs in cases with established epilepsy who are not critically sick. External validation from other parts of the world/centers and a more diverse epilepsy population are required before generalizing the protocol into clinical practice.

Brand-to-generic Levetiracetam Switch in Patients with Epilepsy: Seizure Control and its Predictors in a Real-world Setting

BACKGROUND: Epilepsy is a common neurological disease. Treatment with original antiepileptic drugs may result in high cost. Levetiracetam (LEV) is a broad-spectrum antiepileptic drug. Several studies showed that generic LEV is safe, effective, and saves cost. There are limited data on predictors of seizure control in persons with epilepsy treated with LEV, particularly switch therapy to generic LEV. METHODS: This study was a comparison study conducted at two tertiary care hospitals. One hospital used an original LEV, while another one switched to generic LEV. The outcomes of the study included seizure control after switching to generic LEV treatment, treatment cost, dosage of LEV, adverse events of LEV, switching therapy to original LEV, emergency room visit, and abnormal laboratory tests. These outcomes were compared between the generic and original LEV. Seizure control defined by free of seizure after switch therapy. Predictors of seizure control were analyzed by multiple logistic regression analysis. RESULTS: During the study period, there were 96 eligible patients and treated with generic LEV in 61 patients (63.54%). Regarding treatment outcomes, the generic LEV group had significantly higher proportions of seizure control (91.80% vs. 45.71%) than the original LEV group. The original LEV group had significantly higher cost than the generic LEV group (65,250 vs. 9500 Baht; p < 0.001). The final model had two factors remaining: Generic LEV and frequency of seizure before switch therapy. Generic LEV was independently associated with seizure control with adjusted OR of 6.35 (95% CI of 1.73, 23.34). CONCLUSION: Switch therapy to generic LEV is an alternative therapy with comparable efficacy, lower cost, and safe. Generic LEV and frequency of seizure attack before switch therapy to generic LEV may be related to seizure control.

The Efficacy and Safety Profile of Generic Intravenous Levetiracetam in a Real-World Setting

Background

There are 3 main epileptic conditions in hospital settings that may require intravenous antiepileptic treatment: status epilepticus, acute repetitive convulsive seizures, and postoperative seizures. Generic intravenous levetiracetam (IV LEV) (Focale; Great Eastern Drug Co, Bangkok, Thailand), has been reported to have comparable efficacy to original IV LEV for treating status epilepticus and acute repetitive convulsive seizures in a randomized controlled trial. At present, there are limited data on the efficacy and tolerability of generic intravenous LEV in real-world situations.

Objective

This study aimed to evaluate the clinical outcomes of generic IV LEV in a real-world setting.

Methods

A retrospective study and analyses were conducted. All adult patients who used IV LEV at University Hospital, Khon Kaen University, Thailand from June 1, 2019, until February 15, 2020, were included. Data were analyzed and reported in terms of the efficacy and tolerability of generic IV LEV.

Results

Ninety-three patients received IV LEV by 3 indications: status epilepticus, acute repetitive convulsive seizures, and postoperative seizures. The proportions of these 3 indications were 41.94% (39 patients), 9.67% (9 patients), and 48.39% (45 patients), respectively. The average seizure control rate at 24 hours was 89.25%. The seizure control rate was significantly higher in the acute repetitive convulsive seizures and postoperative seizure groups than in the status epilepticus group when generic IV LEV was given as the first-line treatment (75.00%; 88.37% vs 50.00%; P 0.035). The average length of hospital stay was 18.24 (25.40) days. There was no significant discharge status among the 3 groups (P = 0.348). Moreover, the average mortality rate was 5.38%. Side effects were reported in 14 patients (15.05%). The 2 most common side effects were vomiting and bronchospasm (3 patients; 3.22%). There were 10 patients with uncontrolled seizures at 24 hours (10.75%). The only factor associated with uncontrolled seizures at 24 hours was a history of epilepsy. The uncontrolled seizure group had a higher proportion of epilepsy patients than the seizure-controlled group (70.00% vs 33.73%; P = 0.037). Poor discharge status (not improved/death) was 18.28% (17 patients). There was no significant factor between those with an improved or poor discharge status.

Conclusions

Generic IV LEV was effective and relatively well tolerated in the 3 clinical settings (ie, status epilepticus, acute repetitive convulsive seizures, and postoperative seizures). Further clinical data are still required to confirm the results of this study.

(Curr Ther Res Clin Exp. 2022; 83:XXX–XXX)