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Winter Y, Abou Dargham R, Patiño Tobón S, Groppa S, Fuest S. Cenobamate as an Early Adjunctive Treatment in Drug-Resistant Focal-Onset Seizures: An Observational Cohort Study. CNS Drugs 2024; 38:733-742. [PMID: 39096467 PMCID: PMC11316687 DOI: 10.1007/s40263-024-01109-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND AND OBJECTIVES Cenobamate (CNB) is a new antiseizure medication (ASM) to treat drug-resistant, focal-onset seizures. Data on its use in early therapy lines are not yet available, and clinicians frequently consider CNB to be a later ASM drug choice. We investigated the efficacy and safety of CNB as an early adjunctive treatment in drug-resistant, focal-onset seizures. METHODS The study population were patients with drug-resistant, focal-onset seizures who were initiated with CNB after they did not respond to two or three lifetime ASMs, including all prior and concomitant ASMs. These patients were matched (1:2) by sex, age, and seizure frequency to controls who were initiated with any ASM other than CNB. All participants participated in the Mainz Epilepsy Registry. We evaluated the retention rate after 12 months of CNB and after each new adjunctive ASM in the control group. In addition, seizure freedom and the response rate (reduction of seizure frequency by ≥ 50% from baseline) after 12 months were estimated. RESULTS We included 231 patients aged 44.4 ± 15.8 years. Of these, 33.3% (n = 77) were on CNB, 19.0% (n = 44) on valproate (VPA), 17.3% (n = 40) on lacosamide (LCS), 16.4% (n = 38) on levetiracetam (LEV), and 13.9% (n = 32) on topiramate (TPM). The highest retention rate after 12 months since the beginning of the early adjunctive therapy was observed on CNB (92.0%), compared with LCS (80.0%), LEV (73.3%), VPA (68.2%), or TPM (62.5%) (p < 0.05). Seizure freedom and response rate were also the best on CNB (19.5% and 71.4%, respectively) compared with other ASMs (8.3% and 52.5%, respectively; p < 0.05). No significant differences in adverse events between CNB and other ASMs were observed. CONCLUSIONS Our study provides evidence that CNB is an effective ASM with a good safety profile in the early therapy lines of drug-resistant, focal-onset seizures. This data should support medical decision making in the management of patients with refractory epilepsy. CLINICAL TRIAL ID NCT05267405.
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Affiliation(s)
- Yaroslav Winter
- Mainz Comprehensive Epilepsy and Sleep Medicine Center, Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
- Department of Neurology, Philipps-University Marburg, Marburg, Germany.
| | - Raya Abou Dargham
- Mainz Comprehensive Epilepsy and Sleep Medicine Center, Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Susana Patiño Tobón
- Mainz Comprehensive Epilepsy and Sleep Medicine Center, Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sven Fuest
- Department of Neurology, Hephata Klinik, Schwalmstadt, Germany
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Roberti R, Di Gennaro G, Anzellotti F, Arnaldi D, Belcastro V, Beretta S, Boero G, Bonanni P, Canafoglia L, D'Aniello A, Dainese F, De Caro C, Di Gennaro G, Di Giacomo R, DiFrancesco JC, Dono F, Falcicchio G, Ferlazzo E, Foschi N, Franciotta S, Gambardella A, Giordano A, Iannone LF, Labate A, La Neve A, Lattanzi S, Leggio U, Liguori C, Maschio M, Nilo A, Operto FF, Pascarella A, Pauletto G, Renna R, Strigaro G, Russo E. A real-world comparison among third-generation antiseizure medications: Results from the COMPARE study. Epilepsia 2024; 65:456-472. [PMID: 38052481 DOI: 10.1111/epi.17843] [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: 07/31/2023] [Revised: 11/22/2023] [Accepted: 11/30/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE There are few comparative data on the third-generation antiseizure medications (ASMs). We aimed to assess and compare the effectiveness of brivaracetam (BRV), eslicarbazepine acetate (ESL), lacosamide (LCM), and perampanel (PER) in people with epilepsy (PWE). Efficacy and tolerability were compared as secondary objectives. METHODS This multicenter, retrospective study collected data from 22 Italian neurology/epilepsy centers. All adult PWE who started add-on treatment with one of the studied ASMs between January 2018 and October 2021 were included. Retention rate was established as effectiveness measure and described using Kaplan-Meier curves and the best fitting survival model. The responder status and the occurrence of adverse events (AEs) were used to evaluate efficacy and safety, respectively. The odds of AEs and drug efficacy were estimated by two multilevel logistic models. RESULTS A total of 960 patients (52.92% females, median age = 43 years) met the inclusion criteria. They mainly suffered from structural epilepsy (52.29%) with monthly (46.2%) focal seizures (69.58%). Compared with LCM, all the studied ASMs had a higher dropout risk, statistically significant in the BRV levetiracetam (LEV)-naïve (hazard ratio [HR] = 1.97, 95% confidence interval [CI] = 1.17-3.29) and PER groups (HR = 1.64, 95% CI = 1.06-2.55). Women were at higher risk of discontinuing ESL (HR = 5.33, 95% CI = 1.71-16.61), as well as PER-treated patients with unknown epilepsy etiology versus those with structural etiology (HR = 1.74, 95% CI = 1.05-2.88). BRV with prior LEV therapy showed lower odds of efficacy (odds ratio [OR] = .08, 95% CI = .01-.48) versus LCM, whereas a higher efficacy was observed in women treated with BRV and LEV-naïve (OR = 10.32, 95% CI = 1.55-68.78) versus men. PER (OR = 6.93, 95% CI = 3.32-14.44) and BRV in LEV-naïve patients (OR = 6.80, 95% CI = 2.64-17.52) had a higher chance of AEs than LCM. SIGNIFICANCE Comparative evidence from real-world studies may help clinicians to tailor treatments according to patients' demographic and clinical characteristics.
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Affiliation(s)
- Roberta Roberti
- Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Gianfranco Di Gennaro
- Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Dario Arnaldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Clinical Neurology, University of Genoa, Genoa, Italy
- IRCSS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Simone Beretta
- Department of Neurology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giovanni Boero
- Complex Structure of Neurology, SS Annunziata Hospital, Taranto, Italy
| | - Paolo Bonanni
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute, IRCCS Eugenio Medea, Conegliano, Treviso, Italy
| | - Laura Canafoglia
- Integrated Diagnostics for Epilepsy, Fondazione IRCCS Istituto Neurologico Besta, Milan, Italy
| | | | - Filippo Dainese
- Clinical Neurophysiology Unit, Clinical Neurology, DIDAS Department, Padua, Italy
| | - Carmen De Caro
- Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Roberta Di Giacomo
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Besta, Milan, Italy
| | | | - Fedele Dono
- Department of Neurology, Epilepsy Center, SS Annunziata Hospital, Chieti, Italy
- Department of Neuroscience, Imaging and Clinical Science, D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | | | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
- Regional Epilepsy Center, Bianchi-Melacrino-Morelli Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Nicoletta Foschi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Silvia Franciotta
- Clinical Neurophysiology Unit, Clinical Neurology, DIDAS Department, Padua, Italy
| | - Antonio Gambardella
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Alfonso Giordano
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Luigi Francesco Iannone
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Angelo Labate
- Neurophysiopathology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Angela La Neve
- DiBraiN Department, University of Bari Aldo Moro, Bari, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Ugo Leggio
- Unit of Neurophysiopathology, ASST Spedali Civili, Brescia, Italy
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Neurology Unit, Epilepsy Center, University Hospital Tor Vergata, Rome, Italy
| | - Marta Maschio
- Center for Tumor-Related Epilepsy, UOSD Neuro-Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Annacarmen Nilo
- Clinical Neurology Unit, Department of Head, Neck, and Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery, and Dentistry, University of Salerno, Fisciano, Italy
| | - Angelo Pascarella
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
- Regional Epilepsy Center, Bianchi-Melacrino-Morelli Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Giada Pauletto
- Neurology Unit, Department of Head, Neck, and Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Rosaria Renna
- Neurology and Stroke Unit, Department of Emergency and Acceptance, AORN Antonio Cardarelli Hospital, Naples, Italy
| | - Gionata Strigaro
- Neurology Unit, Department of Translational Medicine, Epilepsy Center, University of Piemonte Orientale, Novara, Italy
- Maggiore della Carità University Hospital, Novara, Italy
| | - Emilio Russo
- Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
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Zelano J, Nika O, Asztely F, Larsson D, Andersson K, Andrén K. Prevalence and nature of patient-reported antiseizure medication side effects in a Swedish regional multi-center study. Seizure 2023; 113:23-27. [PMID: 37931352 DOI: 10.1016/j.seizure.2023.10.016] [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: 08/21/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE Side effects is one of the major clinical problems in epilepsy care. We assessed the prevalence of ASM side effects in participants in a large regional multicenter observational study in western Sweden and aimed to identify risk factors and inventory the nature of side effects with different ASM regimes. METHODS Cross-sectional analysis of survey answers and clinical characteristics of 406 adult participants recruited to a regional observational study between December 2020 and March 2023. Half of the participants had been seizure free for one year. Second-generation or newer ASMs were the most common. RESULTS A total of 164 (40 %, 95 %CI: 36-45) patients reported side effects. Patients reporting side effects were younger (median 41 vs 47 years, p = 0.015), had more frequently experienced a seizure in the last year (p = 0.02), and were more often on ASM polytherapy (p < 0.01). ASM polytherapy and age were significant risk factors in regression models, but the explanatory value was low. The most common side effect was tiredness followed by cognitive symptoms. CONCLUSIONS Our findings show that side effects are still common in epilepsy care and suggests that unnecessary polypharmacy should be avoided. Apart from number or ASMs, predicting who will experience side effects is difficult and more research on individual vulnerability is needed.
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Affiliation(s)
- Johan Zelano
- Department of clinical neuroscience, Institute of neuroscience and physiology, Sahlgrenska Academy, Gothenburg University, Blå stråket 7, 3v, Gothenburg 41345, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Sweden.
| | - Olha Nika
- Department of clinical neuroscience, Institute of neuroscience and physiology, Sahlgrenska Academy, Gothenburg University, Blå stråket 7, 3v, Gothenburg 41345, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Sweden
| | - Fredrik Asztely
- Department of clinical neuroscience, Institute of neuroscience and physiology, Sahlgrenska Academy, Gothenburg University, Blå stråket 7, 3v, Gothenburg 41345, Sweden; Angered hospital, SV hospital group, Gothenburg, Sweden
| | - David Larsson
- Department of clinical neuroscience, Institute of neuroscience and physiology, Sahlgrenska Academy, Gothenburg University, Blå stråket 7, 3v, Gothenburg 41345, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Sweden
| | - Klara Andersson
- Department of clinical neuroscience, Institute of neuroscience and physiology, Sahlgrenska Academy, Gothenburg University, Blå stråket 7, 3v, Gothenburg 41345, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Sweden
| | - Kerstin Andrén
- Department of clinical neuroscience, Institute of neuroscience and physiology, Sahlgrenska Academy, Gothenburg University, Blå stråket 7, 3v, Gothenburg 41345, Sweden; Angered hospital, SV hospital group, Gothenburg, Sweden
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Beltrán-Corbellini Á, Romeral-Jiménez M, Mayo P, Sánchez-Miranda Román I, Iruzubieta P, Chico-García JL, Parra-Díaz P, García-Morales I, Toledano R, Aledo-Serrano Á, Gil-Nagel A. Cenobamate in patients with highly refractory focal epilepsy: A retrospective real-world study. Seizure 2023; 111:71-77. [PMID: 37549616 DOI: 10.1016/j.seizure.2023.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/18/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023] Open
Abstract
PURPOSE To determine the effectiveness and safety outcomes of cenobamate in a cohort of patients with highly refractory focal epilepsy in routine clinical practice. METHODS Observational, retrospective, phase 4 study on subjects receiving cenobamate in three Spanish centers. The primary endpoint was the retention rate at the last follow-up. The main secondary endpoints were the 50%-responder and seizure-free rates at three months and the last follow-up. Other secondary endpoints were Global Clinical Impressions-Improvement (CGI-I) scores and treatment-emergent adverse events (TEAEs). RESULTS Fifty-one patients with highly refractory focal epilepsy with 24.7 years of disease evolution, ten previously tried ASM, and a 23.5% of previous epilepsy surgery were included. The retention rate at the last follow-up was 80.4%. The 50% responder rate in focal seizures at three months was 56.5% (median reduction per month 51%, 0-74.6; p < 0.0001) and in focal to bilateral tonic-clonic seizures was 63.6% (median reduction per month 89%, 0-100; p = 0.022). A total of 54.3% of subjects reported a reduction in the intensity of focal seizures, and 66% manifested clinically significant satisfaction. Cenobamate allowed a significant decrease in concomitant ASM, especially sodium channel blockers. TEAEs were reported in 43.1% of individuals, 85% of whom resolved or improved, with no new safety findings. CONCLUSION In this analysis of patients with highly refractory focal epilepsy treated with cenobamate according to standard clinical practice, there was evidence of a high reduction in both seizure frequency and intensity, with a manageable safety profile.
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Affiliation(s)
| | - María Romeral-Jiménez
- Epilepsy Unit, Department of Neurology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Pablo Mayo
- Epilepsy Unit, Department of Neurology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Pablo Iruzubieta
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
| | - Juan Luis Chico-García
- Epilepsy Unit, Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Paloma Parra-Díaz
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain; Epilepsy Unit, Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Irene García-Morales
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain; Epilepsy Unit, Department of Neurology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Rafael Toledano
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain; Epilepsy Unit, Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ángel Aledo-Serrano
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
| | - Antonio Gil-Nagel
- Epilepsy Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain; Fundación Iniciativa por las Neurociencias (FINCE), Madrid, Spain
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Molina Herranz D, Moreno Sánchez A, López Pisón J, Salinas Salvador B, Carmen Marcen G, Lafuente Hidalgo M, García Íñiguez JP. [Considerations about treatment of childhood epilepsy with lamotrigine]. J Healthc Qual Res 2023; 38:186-190. [PMID: 36241501 DOI: 10.1016/j.jhqr.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/01/2022] [Accepted: 08/22/2022] [Indexed: 05/01/2023]
Affiliation(s)
- D Molina Herranz
- Sección de Neuropediatría y Metabolismo, Servicio de Pediatría,. Hospital Universitario Miguel Servet, Zaragoza, España
| | - A Moreno Sánchez
- Sección de Neuropediatría y Metabolismo, Servicio de Pediatría,. Hospital Universitario Miguel Servet, Zaragoza, España
| | - J López Pisón
- Sección de Neuropediatría y Metabolismo, Servicio de Pediatría,. Hospital Universitario Miguel Servet, Zaragoza, España.
| | - B Salinas Salvador
- Sección de Neuropediatría y Metabolismo, Servicio de Pediatría,. Hospital Universitario Miguel Servet, Zaragoza, España
| | - G Carmen Marcen
- Sección de Neuropediatría y Metabolismo, Servicio de Pediatría,. Hospital Universitario Miguel Servet, Zaragoza, España
| | - M Lafuente Hidalgo
- Sección de Neuropediatría y Metabolismo, Servicio de Pediatría,. Hospital Universitario Miguel Servet, Zaragoza, España
| | - J P García Íñiguez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Miguel Servet, Zaragoza, España
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Chen S, Fukasawa T, Ikeda A, Takeuchi M, Shimotake A, Yoshida S, Kawakami K. Adherence to and persistence with lacosamide, perampanel, lamotrigine, and levetiracetam in adult patients with focal epilepsy in Japan: A descriptive cohort study using a claims database. Heliyon 2023; 9:e15017. [PMID: 37064469 PMCID: PMC10102552 DOI: 10.1016/j.heliyon.2023.e15017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/14/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
Objective We evaluated adherence to and 1-year persistence of two third-generation anti-seizure medications (ASMs), lacosamide and perampanel, in adult patients with focal epilepsy, compared with lamotrigine and levetiracetam. Methods A cohort study was conducted using a Japanese health insurance claims database (JMDC Inc.). We identified patients with adult-onset focal epilepsy who initiated any of the four ASMs between August 31, 2016, and October 31, 2019. Patients were further classified into ASM-naïve patients initiating any of the four ASMs as first-line treatment, and ASM-experienced patients initiating any of the four ASMs as second- or later-line treatment. Outcomes included adherence (proportion of days covered [PDC], defined as the total number of days covered by ASMs divided by the total number of days in the follow-up period) and 1-year persistence for the four ASMs. Results We identified 141 lacosamide, 75 perampanel, 80 lamotrigine, and 530 levetiracetam initiators. Among these, the proportion of ASM-naïve patients was highest in the levetiracetam group (60.8%), followed by the lamotrigine (25.0%), lacosamide (20.6%), and perampanel groups (1.3%). Mean PDC (standard deviation) was similar across the four groups, at 0.95 (0.08) for lacosamide, 0.93 (0.12) for perampanel, 0.92 (0.10) for lamotrigine and 0.94 (0.11) for levetiracetam. The proportion of patients persisting with treatment for 1 year was highest in the lacosamide group (73.0%), followed by the levetiracetam (58.3%), lamotrigine (57.5%), and perampanel groups (54.7%). In ASM-naïve patients, adherence and 1-year persistence were almost identical in the lacosamide, lamotrigine, and levetiracetam groups. Results for ASM-experienced patients did not significantly differ from those of all patients. Significance With regard to adherence and 1-year persistence, lacosamide may be equal to or better than lamotrigine and levetiracetam, especially in patients with experienced ASM, while perampanel may be comparable to lamotrigine and levetiracetam in patients with experienced ASM.
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Affiliation(s)
- Siming Chen
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Toshiki Fukasawa
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
- Department of Digital Health and Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders and Physiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Akihiro Shimotake
- Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satomi Yoshida
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
- Department of Digital Health and Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
- Corresponding author. Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
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Aboumatar S, Krishnaiengar SR, Cantu D, Zhang Y, Grinnell T. Time to baseline seizure count in patients with focal seizures receiving adjunctive eslicarbazepine acetate in a phase IV clinical trial. Clin Neurol Neurosurg 2023; 225:107552. [PMID: 36657359 DOI: 10.1016/j.clineuro.2022.107552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The efficacy and tolerability of eslicarbazepine acetate (ESL), a once-daily, orally-administered, anti-seizure medication (ASM), have primarily been established in treatment-resistant epilepsy patients, the population most often enrolled in clinical trials of anti-seizure medications. More recently, ESL was also shown to be effective and well-tolerated as first adjunctive therapy in non-treatment-resistant patients in an open-label, non-randomized, Phase IV, 24-week study of ESL using standard efficacy parameters in adults with focal seizures. OBJECTIVE To determine the time required to reach baseline seizure count, as an alternative method of assessing the efficacy of adjunctive ESL in patients with relatively low baseline monthly seizure frequencies. This additional analysis was undertaken, as subtle changes and improvements are difficult to analyze using standard efficacy parameters, such as standardized seizure frequency reduction when the baseline frequency of seizures is particularly low. METHODS This was a post-hoc analysis of the Phase IV study data, which investigated time to baseline seizure count in patients aged ≥ 18 years with focal seizures as an alternative measure of anti-seizure efficacy. In the Phase IV trial, patients had been enrolled into 2 groups: Arm 1: ESL as first adjunctive therapy to levetiracetam (LEV) or lamotrigine (LTG), the two most commonly-prescribed ASMs, in patients with inadequate response to treatment; Arm 2: ESL as a later adjunctive therapy, following prior use of 1-2 ASMs in patients who required an additional therapeutic option. RESULTS The time to reach individual baseline seizure count was longer in patients with focal seizures receiving ESL as a first (Arm 1) versus later (Arm 2) adjunctive therapy (p = 0.005). Patients who received ESL as a first adjunctive therapy had a longer time to ESL discontinuation than patients who received ESL as a later adjunctive therapy (p = 0.04). In Arm 1, patients receiving concomitant LTG reported treatment-emergent adverse events (TEAEs) significantly earlier than those receiving LEV (p = 0.02). Compared to patients receiving concomitant LTG, a greater number of patients in Arm 1 who were taking concomitant LEV had a modal ESL dose > 1200 mg and completed the full maintenance period. A greater number of patients in Arm 1 who were receiving concomitant LEV and completed the 24-week maintenance period reached a maximum ESL dose of 1600 mg, compared to those taking LTG, who reached a maximum ESL dose of 1200 mg. CONCLUSIONS This analysis of the Phase IV clinical trial data provides an alternative way of assessing efficacy beyond standardized seizure frequency reduction, in the context of relatively low monthly median seizure frequencies at baseline (SSF 2.0-2.4). These results provide further support for the use of ESL as an earlier or later adjunctive therapy to LEV or LTG.
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Affiliation(s)
- Sami Aboumatar
- Austin Epilepsy Care Center, Suite 203, 2200 Park Bend Drive Building 2, Austin, TX 78758, USA.
| | | | - David Cantu
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA.
| | - Yi Zhang
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA.
| | - Todd Grinnell
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA.
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Strein M, Holton-Burke JP, Stilianoudakis S, Moses C, Almohaish S, Brophy GM. Levetiracetam-associated behavioral adverse events in neurocritical care patients. Pharmacotherapy 2023; 43:122-128. [PMID: 36606737 DOI: 10.1002/phar.2760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/14/2022] [Accepted: 12/11/2022] [Indexed: 01/07/2023]
Abstract
STUDY OBJECTIVES The objective of this study was to identify the incidence of levetiracetam-associated BAEs in NCC patients. DESIGN Single-center retrospective cohort analysis. DATA SOURCE Patient charts. PATIENTS 965 adult ICU patients with a neurological injury receiving levetiracetam that were admitted to an intensive care unit. MEASUREMENTS AND MAIN RESULTS There were 965 patients included; 52% males with a median GCS of 13. Injury types included TBI (43.1%), ICH (21.8%), SAH (20.5%), and CI (14.6%). BAEs were identified in 46% of patients. Of these, 60% had documentation of agitation/restlessness, delirium, or anxiety while receiving levetiracetam, only 25% had a positive CAM-ICU, 13% had restraints ordered, and 42% received antipsychotics. Patients with TBI had the highest incidence of BAEs (52.4%). The median time to initiation of levetiracetam after hospital admission was 6.4 hours and BAEs occurred after 1.3 days of levetiracetam initiation. CONCLUSIONS In this study, we found that almost half of our NCC population experienced levetiracetam associated BAEs which were mostly hyperactive in nature. We believe that the incidence of BAEs in our specific patient population cannot solely be attributed to ICU delirium given the lower risk of developing hyperactive delirium in ICU patients as compared to other subtypes. Therefore, monitoring and determination of the benefit versus risk in those experiencing BAEs is highly encouraged.
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Affiliation(s)
- Micheal Strein
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - John P Holton-Burke
- Rochester Regional Health, Neuroscience Center & Pain Management, Rochester, New York, USA
| | - Spiro Stilianoudakis
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Sulaiman Almohaish
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Pharmacy Practice, Clinical Pharmacy College, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Gretchen M Brophy
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA
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9
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Zhang N, Yang D, Niu C, Li P, Wang H, Li X, Jing W. Comparison of the retention rate, safety, and efficacy of two different titration protocols for lamotrigine in newly diagnosed epilepsy patients. Expert Rev Neurother 2022; 22:1025-1029. [PMID: 36460011 DOI: 10.1080/14737175.2022.2155141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVES To evaluate and compare the retention rate, safety, and efficacy of two different lamotrigine (LTG) titration protocols for newly diagnosed epilepsy patients. METHODS We retrospectively evaluated newly diagnosed epilepsy patients taking LTG from January 2012 to December 2021. In one titration protocol, LTG was taken once daily; in the other, LTG was taken twice daily. Clinical characteristics, seizure outcomes, adverse effects and patient retention rates were evaluated. RESULTS A total of 193 patients were included. There was no significant difference in seizure outcomes or adverse effects between patients treated with LTG once daily and twice daily. However, the retention rates were significantly higher in the once-daily group than in the twice-daily group (73.03% and 55.77%, respectively). CONCLUSION The effectiveness and safety of LTG were not significantly different between the two different LTG titration protocols groups. However, the retention rate of the patients treated with LTG once daily was higher than that of the patients treated with LTG twice daily.
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Affiliation(s)
- Ning Zhang
- Department of Neurology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, 030032, Taiyuan, China.,Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Debo Yang
- Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical SciencesTongji Shanxi Hospital, 030032, Taiyuan, China
| | - Cailang Niu
- Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical SciencesTongji Shanxi Hospital, 030032, Taiyuan, China
| | - Penghong Li
- Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical SciencesTongji Shanxi Hospital, 030032, Taiyuan, China
| | - Huiqin Wang
- Department of Neurology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, 030032, Taiyuan, China.,Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Xinyi Li
- Department of Neurology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, 030032, Taiyuan, China.,Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Wei Jing
- Department of Neurology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, 030032, Taiyuan, China.,Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
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10
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Efficacy of cenobamate for uncontrolled focal seizures in patients with previous epilepsy-related surgery: Post hoc analysis of a phase 3, multicenter, open-label study. Epilepsy Res 2022; 184:106952. [DOI: 10.1016/j.eplepsyres.2022.106952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/06/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022]
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11
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Kopciuch D, Fliciński J, Steinborn B, Winczewska-Wiktor A, Paczkowska A, Zaprutko T, Ratajczak P, Nowakowska E, Kus K. Pharmacoeconomics Aspects of Antiepileptic Drugs in Pediatric Patients with Epilepsy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127517. [PMID: 35742766 PMCID: PMC9223520 DOI: 10.3390/ijerph19127517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 02/01/2023]
Abstract
Objective: This study assessed the differentiation of treatment costs with newer and older antiepileptic drugs (AEDs) through its correlation with treatment effectiveness and an adverse event (AE) in pediatric patients with epilepsy (PPE). Methods: PPE on monotherapy of AEDs for the last 6 months were screened for this study. Seizure frequency during the study was compared with that within 6 months before the study. The following parameters were also assessed: quality of life in epilepsy, Pittsburgh Sleep Quality Index, and Liverpool AEs Profile. An incremental cost-effectiveness ratio (ICER) analysis based on the costs of pharmacotherapy was also performed. Results: Out of 80 PPE, 67 completed the study, and 13 PPE were lost after failing to meet the inclusion criteria. A total of 56.71% of PPE were on newer AEDs, and 43.28% were on older AEDs. Newer and older AEDs did not differ significantly in seizure frequency reduction and quality of life parameters, although these were improved significantly during the study period. As per ICER, newer AEDs need an additional EUR 36.82 per unit reduction in seizure frequency. Conclusion: Newer AEDs have comparatively better efficacy, although not significantly better than older AEDs. However, the additional cost per unit improvement is quite high with newer AEDs, necessitating pharmacoeconomic consideration in pediatric epilepsy treatment.
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Affiliation(s)
- Dorota Kopciuch
- Department of Pharmacoeconomics and Social Pharmacy, Karol Marcinkowski University of Medical Sciences in Poznań, 60-865 Poznan, Poland; (A.P.); (T.Z.); (P.R.); (K.K.)
- Correspondence: ; Tel./Fax: +48-6-1854-6894
| | - Jędrzej Fliciński
- Department of Developmental Neurology, Karol Marcinkowski University of Medical Sciences in Poznań, 60-355 Poznan, Poland; (J.F.); (B.S.); (A.W.-W.)
| | - Barbara Steinborn
- Department of Developmental Neurology, Karol Marcinkowski University of Medical Sciences in Poznań, 60-355 Poznan, Poland; (J.F.); (B.S.); (A.W.-W.)
| | - Anna Winczewska-Wiktor
- Department of Developmental Neurology, Karol Marcinkowski University of Medical Sciences in Poznań, 60-355 Poznan, Poland; (J.F.); (B.S.); (A.W.-W.)
| | - Anna Paczkowska
- Department of Pharmacoeconomics and Social Pharmacy, Karol Marcinkowski University of Medical Sciences in Poznań, 60-865 Poznan, Poland; (A.P.); (T.Z.); (P.R.); (K.K.)
| | - Tomasz Zaprutko
- Department of Pharmacoeconomics and Social Pharmacy, Karol Marcinkowski University of Medical Sciences in Poznań, 60-865 Poznan, Poland; (A.P.); (T.Z.); (P.R.); (K.K.)
| | - Piotr Ratajczak
- Department of Pharmacoeconomics and Social Pharmacy, Karol Marcinkowski University of Medical Sciences in Poznań, 60-865 Poznan, Poland; (A.P.); (T.Z.); (P.R.); (K.K.)
| | - Elżbieta Nowakowska
- Department of Pharmacology and Toxicology Institute of Health Sciences, Collegium Medicum, University of Zielona Gora, 65-417 Zielona Góra, Poland;
| | - Krzysztof Kus
- Department of Pharmacoeconomics and Social Pharmacy, Karol Marcinkowski University of Medical Sciences in Poznań, 60-865 Poznan, Poland; (A.P.); (T.Z.); (P.R.); (K.K.)
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12
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Lee K, Klein P, Dongre P, Choi EJ, Rhoney DH. Intravenous Brivaracetam in the Management of Acute Seizures in the Hospital Setting: A Scoping Review. J Intensive Care Med 2022; 37:1133-1145. [PMID: 35306914 PMCID: PMC9393655 DOI: 10.1177/08850666211073598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Clinical considerations for drug treatment of acute seizures involve
variables such as safety, tolerability, drug-drug interactions, dosage,
route of administration, and alterations in pharmacokinetics because of
critical illness. Therapy options that are easily and quickly administered
without dilution, well tolerated, and effective are needed for the treatment
of acute seizures. The objective of this review is to focus on the clinical
considerations relating to the use of intravenous brivaracetam (IV BRV) for
the treatment of acute seizures in the hospital, focusing on critically ill
patients. Methods This was a scoping literature review of PubMed from inception to April 13,
2021, and search of the American Academy of Neurology (AAN) 2021 Annual
Meeting website for English language publications/conference abstracts
reporting the results of IV BRV use in hospitalized patients, particularly
in the critical care setting. Outcomes of interest relating to the clinical
pharmacology, safety, tolerability, efficacy, and effectiveness of IV BRV
were reviewed and are discussed. Results Twelve studies were included for analysis. One study showed that plasma
concentrations of IV BRV 15 min after the first dose were similar between
patients receiving IV BRV as bolus or infusion. IV BRV was generally well
tolerated in patients with acute seizures in the hospital setting, with a
low incidence of individual TEAEs classified as behavioral disorders. IV BRV
demonstrated efficacy and effectiveness and had a rapid onset, with clinical
and electrophysiological improvement in seizures observed within minutes.
Although outside of the approved label, findings from several studies
suggest that IV BRV reduces seizures and is generally well tolerated in
patients with status epilepticus. Conclusions IV BRV shows effectiveness, and is generally well tolerated in the management
of acute seizures in hospitalized patients where rapid administration is
needed, representing a clinically relevant antiseizure medication for
potential use in the critical care setting.
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Affiliation(s)
- Kiwon Lee
- Department of Neurology, Division of Stroke and Critical Care, Rutgers, The State University of New Jersey, 12287Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA
| | | | | | - Denise H Rhoney
- 15521UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, NC, USA
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13
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Lee JW, Kim JA, Kim MY, Lee SK. Evaluation of persistence and healthcare utilization in patients treated with anti-seizure medications as add-on therapy: A nationwide cohort study in South Korea. Epilepsy Behav 2022; 126:108459. [PMID: 34902660 DOI: 10.1016/j.yebeh.2021.108459] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/12/2021] [Accepted: 11/21/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare medication adherence and healthcare utilization among patients who were treated with anti-seizure medications (ASMs) as first add-on to monotherapy for epilepsy using the national health insurance claims data. METHODS A retrospective observational cohort study was conducted using the Korean National Health Insurance claims data. Patients who received ASM as first add-on to monotherapy during January 2017 to February 2018 were included. The selected patients were followed up for 12 months to evaluate persistence, adherence, and healthcare resource utilization. RESULTS In total, 4277 patients who received ASM as first add-on to monotherapy for epilepsy were enrolled. The mean treatment duration of add-on ASM was 296.6 ± 108.6 days during the 1-year follow-up period and 64.3% of the total population were persistent on the add-on ASM at 365 days from the index date. The mean medication possession ratio (MPR) was 90.3 ± 23.7 and the proportion of adherent patients with ≥80% MPR was 79.3%. Lamotrigine (LTG), levetiracetam (LEV), oxcarbazepine (OXC), and perampanel (PER) groups showed significantly higher persistence and adherence than carbamazepine (CBZ), topiramate (TPM), and valproate (VAL) groups during the 1-year follow-up period. Significant differences in length of stays, total hospitalization cost, outpatient visit cost, and emergency cost were shown between ASM groups and LTG, LEV, OXC, and PER showed relatively low utilization and cost. CONCLUSIONS Better adherence was observed in LTG, LEV, OXC, and PER groups than in CBZ, TPM, and VAL groups. Healthcare utilization and related costs showed significant difference between ASM groups.
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Affiliation(s)
- Ji Woong Lee
- Medical, Eisai Korea Inc., 6 Bongeunsa-ro 86-gil, Gangnam-gu, Seoul, Republic of Korea.
| | - Jung-Ae Kim
- Real World Insights, IQVIA Korea, 173 Toegye-ro, Jung-gu, Seoul, Republic of Korea.
| | - Min Young Kim
- Medical, Eisai Korea Inc., 6 Bongeunsa-ro 86-gil, Gangnam-gu, Seoul, Republic of Korea.
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
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14
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Im K, Lee SA, Kim JH, Kim DW, Lee SK, Seo DW, Lee JW. Long-term efficacy and safety of perampanel as a first add-on therapy in patients with focal epilepsy: Three-year extension study. Epilepsy Behav 2021; 125:108407. [PMID: 34785411 DOI: 10.1016/j.yebeh.2021.108407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/20/2021] [Accepted: 10/23/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE We investigated the long-term efficacy and safety of perampanel as a first add-on therapy in patients with focal epilepsy. METHODS This retrospective study represented the 3-year extension phase of a multicenter, open-label, phase 4, prospective study of perampanel as a first add-on therapy in patients with focal epilepsy. Seizure and safety outcomes were assessed annually from the start of the extension study, and the retention rate was calculated from the start of perampanel exposure in the original study. RESULTS The 50% responder and seizure freedom rates were 84.8% and 58.7%, respectively, during the third year and 71.7% and 32.6%, respectively, during the entire 3-year period of the extension study. The 1-, 2-, and 3-year retention rates were 62.5%, 53.1%, and 52.1%, respectively. Efficacies were higher in patients that were aged >55 years, male, and receiving ≤4 mg of perampanel. Perampanel was generally well tolerated; 47.3% of patients experienced at least one adverse event during the 3 years of extension (46 adverse events (AEs) in 35 patients). The most common AEs were dizziness (33.8%), somnolence (5.4%), anger (4.1%), and irritability (4.1%). AEs were resolved with perampanel dose reduction or discontinuation in 10 (13.5%) and 12 (16.2%) patients, respectively. CONCLUSION Long-term treatment with perampanel as a first add-on therapy did not raise new safety signals in patients with focal epilepsy. Especially at low perampanel doses (≤4 mg/day), sustained improvement in seizure control was achieved, which could potentially avoid adverse drug reactions.
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Affiliation(s)
- Kayeong Im
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Ji Hyun Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dae Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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15
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Sander JW, Rosenfeld WE, Halford JJ, Steinhoff BJ, Biton V, Toledo M. Long-term individual retention with cenobamate in adults with focal seizures: Pooled data from the clinical development program. Epilepsia 2021; 63:139-149. [PMID: 34813673 PMCID: PMC9299487 DOI: 10.1111/epi.17134] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022]
Abstract
Objective We determined retention on open‐label cenobamate therapy in the clinical development program to assess the long‐term efficacy and tolerability of adjunctive cenobamate in individuals with uncontrolled focal seizures. Methods Data from two randomized, controlled cenobamate studies and one open‐label safety and pharmacokinetic study were pooled. Based on the percentage of participants remaining on treatment, retention rates were estimated using Kaplan‐Meier survival analyses. We performed two additional analyses to assess factors contributing to retention, stratifying a robust data set (through 2 years) by cenobamate modal dose and frequently used concomitant anti‐seizure medications. Cenobamate discontinuations and treatment‐emergent adverse events were summarized. Results Data from 1844 participants were pooled: 149 from a single‐dose randomized trial, 355 from a multi‐dose randomized trial, and 1340 from an open‐label safety and pharmacokinetic study. Most participants from randomized trials continued in open‐label extensions, and pooled data represent >95% of participants exposed to cenobamate. Baseline characteristics and disease and treatment histories were similar across studies. Median duration of cenobamate exposure was 34 months, with a median modal dose of 200 mg/day. Kaplan‐Meier estimates of cumulative cenobamate retention rates were 80% at 1 year and 72% at 2 years. Once participants reached the maintenance phase, retention rates were consistently high in participants receiving ≥100 mg/day cenobamate, and concomitant anti‐seizure medications did not affect long‐term retention. By 2 years, 535 (29%) had actually discontinued cenobamate; the most common reasons for discontinuation were adverse events (37.6%), withdrawal of consent (21.1%), and other (16.8%). Significance Treatment retention rates provide a proxy measure for long‐term efficacy, safety, tolerability, and adherence. The consistently high retention rates we found suggest that cenobamate may be an effective and well‐tolerated new treatment option for people with drug‐resistant focal seizures.
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Affiliation(s)
- Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St. Peter, UK.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - William E Rosenfeld
- Comprehensive Epilepsy Care Center for Children and Adults, St. Louis, Missouri, USA
| | - Jonathan J Halford
- Comprehensive Epilepsy Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bernhard J Steinhoff
- Department of Neurology and Clinical Neurophysiology, Kork Epilepsy Center, Kehl-Kork, Germany.,Clinic for Neurology and Neurophysiology, Freiburg, Germany
| | - Victor Biton
- Arkansas Epilepsy Program, Little Rock, Arkansas, USA
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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16
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Rosenfeld WE, Abou-Khalil B, Aboumatar S, Bhatia P, Biton V, Krauss GL, Sperling MR, Vossler DG, Klein P, Wechsler R. Post hoc analysis of a phase 3, multicenter, open-label study of cenobamate for treatment of uncontrolled focal seizures: Effects of dose adjustments of concomitant antiseizure medications. Epilepsia 2021; 62:3016-3028. [PMID: 34633074 PMCID: PMC9292883 DOI: 10.1111/epi.17092] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 01/23/2023]
Abstract
Objective To report post hoc results on how adjustments to baseline antiseizure medications (ASMs) in a subset of study sites (10 US sites) from a long‐term, open‐label phase 3 study of adjunctive cenobamate affected tolerability, efficacy, and retention. Methods Patients with uncontrolled focal seizures taking stable doses of one to three ASMs were administered increasing doses of cenobamate (12.5, 25, 50, 100, 150, 200 mg/day) over 12 weeks at 2‐week intervals (target dose = 200 mg/day). Further increases to 400 mg/day by 50 mg/day biweekly increments were allowed during maintenance phase. Dose adjustments of cenobamate and concomitant ASMs were allowed. Data were assessed until last visit, at data cut‐off, on or after September 1, 2019. Results A total of 240 patients meeting eligibility criteria were assessed (median [max] exposure 30.2 [43.0] months), with 177 patients continuing cenobamate at data cut‐off. Most common baseline concomitant ASMs were lacosamide, levetiracetam, lamotrigine, zonisamide, and clobazam. For most baseline concomitant ASMs, ~70% of patients taking that ASM were continuing cenobamate at data cut‐off. Patients continuing cenobamate had greater mean ASM dose reductions and percent dose changes from baseline vs those who discontinued. Of patients continuing cenobamate, 24.6% discontinued one or more concomitant ASMs completely. Dose decreases for all concomitant ASMs generally occurred during titration or early maintenance phases and were mostly due to central nervous system (CNS)–related adverse events such as somnolence, dizziness, unsteady gait, and fatigue. Responder rates from ≥50% through 100% for patients continuing cenobamate were generally similar regardless of concomitant ASMs (of those most commonly taken), with ~81% being ≥50% responders and ~12% achieving 100% seizure reduction in the maintenance phase, which lasted up to 40.2 (median = 29.5) months. Significance Concomitant ASM dose reductions were associated with more patients remaining on cenobamate. This is likely due to efficacy and improved tolerability, with overall reduced concomitant drug burden in patients with uncontrolled seizures despite taking one to three baseline concomitant ASMs.
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Affiliation(s)
- William E Rosenfeld
- Comprehensive Epilepsy Care Center for Children and Adults, St. Louis, Missouri, USA
| | | | | | | | - Victor Biton
- Arkansas Epilepsy Program, Little Rock, Arkansas, USA
| | - Gregory L Krauss
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - David G Vossler
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, Maryland, USA
| | - Robert Wechsler
- Consultants in Epilepsy & Neurology, PLLC, Boise, Idaho, USA.,Idaho Comprehensive Epilepsy Center, Boise, Idaho, USA
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17
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Strzelczyk A, Zaveta C, von Podewils F, Möddel G, Langenbruch L, Kovac S, Mann C, Willems LM, Schulz J, Fiedler B, Kurlemann G, Schubert-Bast S, Rosenow F, Beuchat I. Long-term efficacy, tolerability, and retention of brivaracetam in epilepsy treatment: A longitudinal multicenter study with up to 5 years of follow-up. Epilepsia 2021; 62:2994-3004. [PMID: 34608628 DOI: 10.1111/epi.17087] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study was undertaken to evaluate the long-term efficacy, retention, and tolerability of add-on brivaracetam (BRV) in clinical practice. METHODS A multicenter, retrospective cohort study recruited all patients who initiated BRV between February and November 2016, with observation until February 2021. RESULTS Long-term data for 262 patients (mean age = 40 years, range = 5-81 years, 129 men) were analyzed, including 227 (87%) diagnosed with focal epilepsy, 19 (7%) with genetic generalized epilepsy, and 16 (6%) with other or unclassified epilepsy syndromes. Only 26 (10%) patients had never received levetiracetam (LEV), whereas 133 (50.8%) were switched from LEV. The length of BRV exposure ranged from 1 day to 5 years, with a median retention time of 1.6 years, resulting in a total BRV exposure time of 6829 months (569 years). The retention rate was 61.1% at 12 months, with a reported efficacy of 33.1% (79/239; 50% responder rate, 23 patients lost-to-follow-up), including 10.9% reported as seizure-free. The retention rate for the entire study period was 50.8%, and at last follow-up, 133 patients were receiving BRV at a mean dose of 222 ± 104 mg (median = 200, range = 25-400), including 52 (39.1%) who exceeded the recommended upper dose of 200 mg. Fewer concomitant antiseizure medications and switching from LEV to BRV correlated with better short-term responses, but no investigated parameters correlated with positive long-term outcomes. BRV was discontinued in 63 (24%) patients due to insufficient efficacy, in 29 (11%) for psychobehavioral adverse events, in 25 (10%) for other adverse events, and in 24 (9%) for other reasons. SIGNIFICANCE BRV showed a clinically useful 50% responder rate of 33% at 12 months and overall retention of >50%, despite 90% of included patients having previous LEV exposure. BRV was well tolerated; however, psychobehavioral adverse events occurred in one out of 10 patients. Although we identified short-term response and retention predictors, we could not identify significant predictors for long-term outcomes.
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Affiliation(s)
- Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Clara Zaveta
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix von Podewils
- Epilepsy Center Greifswald and Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Gabriel Möddel
- Epilepsy Center Münster-Osnabrück, Department of Neurology With Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Lisa Langenbruch
- Epilepsy Center Münster-Osnabrück, Department of Neurology With Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Stjepana Kovac
- Epilepsy Center Münster-Osnabrück, Department of Neurology With Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Catrin Mann
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Juliane Schulz
- Epilepsy Center Greifswald and Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Barbara Fiedler
- Department of Neuropediatrics, University of Münster, Münster, Germany
| | - Gerhard Kurlemann
- Department of Neuropediatrics, University of Münster, Münster, Germany.,St. Bonifatius Hospital, Lingen, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany.,Department of Neuropediatrics, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Isabelle Beuchat
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
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18
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Hakami T. Efficacy and tolerability of antiseizure drugs. Ther Adv Neurol Disord 2021; 14:17562864211037430. [PMID: 34603506 PMCID: PMC8481725 DOI: 10.1177/17562864211037430] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/19/2021] [Indexed: 12/17/2022] Open
Abstract
Drug-resistant epilepsy occurs in 25-30% of patients. Furthermore, treatment with a first-generation antiseizure drug (ASD) fails in 30-40% of individuals because of their intolerable adverse effects. Over the past three decades, 20 newer- (second- and third-)generation ASDs with unique mechanisms of action and pharmacokinetic profiles have been introduced into clinical practice. This advent has expanded the therapeutic armamentarium of epilepsy and broadens the choices of ASDs to match the individual patient's characteristics. In recent years, research has been focused on defining the ASD of choice for different seizure types. In 2017, the International League Against Epilepsy published a new classification for seizure types and epilepsy syndrome. This classification has been of paramount importance to accurately classify the patient's seizure type(s) and prescribe the ASD that is appropriate. A year later, the American Academy of Neurology published a new guideline for ASD selection in adult and pediatric patients with new-onset and treatment-resistant epilepsy. The guideline primarily relied on studies that compare the first-generation and second-generation ASDs, with limited data for the efficacy of third-generation drugs. While researchers have been called for investigating those drugs in future research, epilepsy specialists may wish to share their personal experiences to support the treatment guidelines. Given the rapid advances in the development of ASDs in recent years and the continuous updates in definitions, classifications, and treatment guidelines for seizure types and epilepsy syndromes, this review aims to present a complete overview of the current state of the literature about the efficacy and tolerability of ASDs and provide guidance to clinicians about selecting appropriate ASDs for initial treatment of epilepsy according to different seizure types and epilepsy syndromes based on the current literature and recent US and UK practical guidelines.
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Affiliation(s)
- Tahir Hakami
- The Faculty of Medicine, Jazan University, P.O. Box 114, Jazan 45142, Saudi Arabia
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19
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Eck K, Rauch C, Kerling F, Hamer H, Winterholler M. Long-term effects of zonisamide in adult patients with intellectual disability. Acta Neurol Scand 2021; 144:275-282. [PMID: 33914900 DOI: 10.1111/ane.13443] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/06/2021] [Accepted: 04/13/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to evaluate the tolerability and efficacy of zonisamide (ZNS) in adult patients with drug-resistant epilepsy and intellectual disability (ID) at our epilepsy centre. PATIENTS AND METHODS By conducting a monocentric, open-label observational study based on standardized seizure records we retrospectively assessed 87 patients (39 female, mean age 40.6 ± 13.6, range 18-75 years) with ID and drug-resistant epilepsy. Evaluation, including calculation of retention rate, was performed for the intervals 3-6, 9-12 and 21-24 months after ZNS initiation. The Clinical Global Impressions Scale-Improvement (CGI-I) was used to detect qualitative changes in seizure severity and clinical status. Via regression analysis and the generalized estimating equations approach, we examined changes in body weight and impact of patient age also considering associations with other patient characteristics. RESULTS The retention rate after 24 months was 60%. 28% discontinued ZNS therapy due to increasing seizure frequency, lack of efficacy or adverse events (AEs). Sedation (38%), language impairment (19%), challenging behaviour (10%), mild rash (10%) and dizziness (10%) were the commonest AEs. The responder rate was 40%, eight patients (9%) became seizure free. We found CGI-I to be dose-dependent. Regarding changes in body weight, we observed no difference between patients continuing or withdrawing ZNS therapy and responders or non-responders. Though, we identified older age as a significant risk factor for weight loss. CONCLUSIONS Zonisamide may provide a safe and efficient therapeutic option for patients with ID and drug-resistant epilepsy. However, weight status should be carefully monitored, especially in elderly patients.
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Affiliation(s)
- Kattrinna Eck
- Department of Neurology Epilepsy CenterSana‐Krankenhaus Rummelsberg (teaching hospital of the Friedrich‐Alexander‐Universität Erlangen‐Nürnberg) Schwarzenbruck Germany
| | - Christophe Rauch
- Department of Neurology Epilepsy CenterSana‐Krankenhaus Rummelsberg (teaching hospital of the Friedrich‐Alexander‐Universität Erlangen‐Nürnberg) Schwarzenbruck Germany
| | - Frank Kerling
- Department of Neurology Epilepsy CenterSana‐Krankenhaus Rummelsberg (teaching hospital of the Friedrich‐Alexander‐Universität Erlangen‐Nürnberg) Schwarzenbruck Germany
| | - Hajo Hamer
- Department of Neurology Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen Germany
| | - Martin Winterholler
- Department of Neurology Epilepsy CenterSana‐Krankenhaus Rummelsberg (teaching hospital of the Friedrich‐Alexander‐Universität Erlangen‐Nürnberg) Schwarzenbruck Germany
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20
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French JA, Chung SS, Krauss GL, Lee SK, Maciejowski M, Rosenfeld WE, Sperling MR, Kamin M. Long-term safety of adjunctive cenobamate in patients with uncontrolled focal seizures: Open-label extension of a randomized clinical study. Epilepsia 2021; 62:2142-2150. [PMID: 34254673 PMCID: PMC8456960 DOI: 10.1111/epi.17007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 12/28/2022]
Abstract
Objective This study was undertaken to examine long‐term (up to 7.8 years) retention rate, safety, and tolerability of the antiseizure medication (ASM) cenobamate as adjunctive treatment in the open‐label extension (OLE) of study YKP3089C013 (C013; ClinicalTrials.gov: NCT01397968). Methods Patients who completed the 12‐week, multicenter, multinational, double‐blind, randomized, placebo‐controlled C013 study, which examined adjunctive cenobamate treatment of adults with uncontrolled focal seizures, were eligible to enroll in the OLE. During the OLE, dose adjustments of cenobamate and concomitant ASMs were allowed. Safety assessments included frequency of treatment‐emergent adverse events (TEAEs) and serious TEAEs, TEAE severity, and TEAEs leading to discontinuation. Probability of patient continuation in the OLE was examined using a Kaplan–Meier analysis. Results One hundred forty‐nine patients entered the OLE (median duration of cenobamate treatment = 6.25 years). As of the data cutoff, 57% of patients (85/149) remained in the OLE (median treatment duration = 6.8 years, range = 6.4–7.8 years). The median modal daily cenobamate dose was 200 mg (range = 50–400 mg). The probability of treatment continuation at 1–6 years of cenobamate treatment was 73%, 67%, 63%, 61%, 60%, and 59%, respectively. Among patients who continued at 1 year (n = 107), the probability of continuing at Years 2–5 was 92%, 87%, 83%, and 82%. The most common discontinuation reasons were patient withdrawal (19.5%, 29/149), adverse event (10.1%, 15/149), and lack of efficacy (5.4%, 8/149). TEAEs leading to discontinuation in 1% or more of patients were fatigue (1.3%, 2/149), ataxia (1.3%, 2/149), and memory impairment or amnesia (1.3%, 2/149). Dizziness (32.9%, 49/149), headache (26.8%, 40/149), and somnolence (21.5%, 32/149) were the most frequently reported TEAEs and were primarily mild or moderate in severity. Significance Long‐term retention in the C013 OLE study demonstrated sustained safety and tolerability of adjunctive cenobamate treatment up to 7.8 years in adults with treatment‐resistant focal seizures taking one to three ASMs.
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Affiliation(s)
- Jacqueline A French
- New York University Langone Comprehensive Epilepsy Center, New York, New York, USA
| | - Steve S Chung
- Neuroscience Institute, Banner-University Medical Center, University of Arizona, Phoenix, Arizona, USA
| | - Gregory L Krauss
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sang Kun Lee
- Adult Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, Republic of Korea
| | | | - William E Rosenfeld
- Comprehensive Epilepsy Care Center for Children and Adults, St. Louis, Missouri, USA
| | | | - Marc Kamin
- SK Life Science, Paramus, New Jersey, USA
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21
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Lee H, Kim DW. Usefulness of extended-release topiramate in patients with epilepsy: A two-year retention study. J Clin Pharm Ther 2021; 46:1412-1417. [PMID: 34146432 DOI: 10.1111/jcpt.13473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/03/2021] [Accepted: 06/09/2021] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Extended-release topiramate (TPM-XR) was recently approved for the treatment of epilepsy, but there is only limited real-world information on the clinical usefulness of TPM-XR in epilepsy patients. We investigated the usefulness of TPM-XR in clinical practice by analysing the retention of TPM-XR in adult epilepsy patients. METHODS We performed a single-centre retrospective study covering two years. Epilepsy patients taking TPM-XR were included in the study and classified into one of three groups: the monotherapy group, in which patients took only TPM-XR; the adjunctive therapy group, in which patients took TPM-XR concomitant with other AEDs; and the switching AED regimen group, in which patient's AED was switched from immediate-release TPM (TPM-IR) to TPM-XR. We evaluated the retention rates of TPM-XR and analysed the differences in retention rate among the three patient groups. RESULTS AND DISCUSSION We included 164 epilepsy patients who received TPM-XR for the treatment of epilepsy. The overall retention rate of TPM-XR was generally favourable: 79.1% after one year and 77.7% after two years. The switching AED regimen group had a better retention rate than the other two groups (p = 0.04), with a one-year retention rate of 90.6% and a two-year retention rate of 88.1%. WHAT IS NEW AND CONCLUSION The favourable retention rate of TPM-XR shows that TPM-XR can be an effective treatment option for epilepsy patients, as either a monotherapy or as an adjunctive therapy. Additionally, switching AED regimen to TPM-XR from TPM-IR can be considered in selected epilepsy patients with poor adherence to TPM-IR.
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Affiliation(s)
- Hyemi Lee
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea
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22
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Steinhoff BJ, Klein P, Klitgaard H, Laloyaux C, Moseley BD, Ricchetti-Masterson K, Rosenow F, Sirven JI, Smith B, Stern JM, Toledo M, Zipfel PA, Villanueva V. Behavioral adverse events with brivaracetam, levetiracetam, perampanel, and topiramate: A systematic review. Epilepsy Behav 2021; 118:107939. [PMID: 33839453 DOI: 10.1016/j.yebeh.2021.107939] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE To understand the currently available post-marketing real-world evidence of the incidences of and discontinuations due to the BAEs of irritability, anger, and aggression in people with epilepsy (PWE) treated with the anti-seizure medications (ASMs) brivaracetam (BRV), levetiracetam (LEV), perampanel (PER), and topiramate (TPM), as well as behavioral adverse events (BAEs) in PWE switching from LEV to BRV. METHODS A systematic review of published literature using the Cochrane Library, PubMed/MEDLINE, and Embase was performed to identify retrospective and prospective observational studies reporting the incidence of irritability, anger, or aggression with BRV, LEV, PER, or TPM in PWE. The incidences of these BAEs and the rates of discontinuation due to each were categorized by ASM, and where possible, weighted means were calculated but not statistically assessed. Behavioral and psychiatric adverse events in PWE switching from LEV to BRV were summarized descriptively. RESULTS A total of 1500 records were identified in the searches. Of these, 44 published articles reporting 42 studies met the study criteria and were included in the data synthesis, 7 studies were identified in the clinical trial database, and 5 studies included PWE switching from LEV to BRV. Studies included a variety of methods, study populations, and definitions of BAEs. While a wide range of results was reported across studies, weighted mean incidences were 5.6% for BRV, 9.9% for LEV, 12.3% for PER, and 3.1% for TPM for irritability; 3.3%* for BRV, 2.5% for LEV, 2.0% for PER, and 0.2%* for TPM for anger; and 2.5% for BRV, 2.6% for LEV, 4.4% for PER, and 0.5%* for TPM for aggression. Weighted mean discontinuation rates were 0.8%* for BRV, 3.4% for LEV, 3.0% for PER, and 2.2% for TPM for irritability and 0.8%* for BRV, 2.4% for LEV, 9.2% for PER, and 1.2%* for TPM for aggression. There were no discontinuations for anger. Switching from LEV to BRV led to improvement in BAEs in 33.3% to 83.0% of patients (weighted mean, 66.6%). *Denotes only 1 study. CONCLUSIONS This systematic review characterizes the incidences of irritability, anger, and aggression with BRV, LEV, PER, and TPM, and it provides robust real-world evidence demonstrating that switching from LEV to BRV may improve BAEs. While additional data remain valuable due to differences in methodology (which make comparisons difficult), these results improve understanding of the real-world incidences of discontinuations due to these BAEs in clinical practice and can aid in discussions and treatment decision-making with PWE.
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Affiliation(s)
- Bernhard J Steinhoff
- Epilepsiezentrum Kork, Landstraße 1, 77694 Kehl, Kehl-Kork; Albert-Ludwigs University of Freiburg, Department of Neurology and Clinical Neurophysiology, Freiburg, Germany.
| | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, 6410 Rockledge Drive, #610, Bethesda, MD 20817, USA.
| | - Henrik Klitgaard
- UCB Pharma, Allee de la Recherche 60, 1070 Anderlecht, Brussels, Belgium.
| | - Cédric Laloyaux
- UCB Pharma, Allee de la Recherche 60, 1070 Anderlecht, Brussels, Belgium.
| | - Brian D Moseley
- University of Cincinnati, Department of Neurology and Rehabilitation Medicine, Stetson Building, 260 Stetson Street, Suite 2300, Cincinnati, OH 45267-0525, USA
| | | | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, Schleusenweg 2-12, Haus 95, Frankfurt a.M., 60528, Germany.
| | - Joseph I Sirven
- Mayo Clinic, Neurology and Neurosurgery, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.
| | - Brien Smith
- OhioHealth Physician Group, 3430 OhioHealth Pkwy, 4th Floor North, Columbus, OH 43202, USA.
| | - John M Stern
- University of California, Department of Neurology, 300 Medical Plaza Driveway, Suite B200, Los Angeles, CA 90095, USA.
| | - Manuel Toledo
- Epilepsy Unit. Neurology Department, Hospital Vall d'Hebron, Servicio de Neurologia, Passeig de la Vall d'Hebron 119, Barcelona, 08035, Spain.
| | - Patricia A Zipfel
- MicroMass, an Ashfield Company, 100 Regency Forest Dr, Cary, NC, USA.
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Hospital Universitario y Politecnico La Fe, Avenida Fernando Abril Martorell 106, Valencia 46026, Spain
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23
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van der Meer PB, Koekkoek JAF, van den Bent MJ, Dirven L, Taphoorn MJB. Effect of antiepileptic drugs in glioma patients on self-reported depression, anxiety, and cognitive complaints. J Neurooncol 2021; 153:89-98. [PMID: 33822293 PMCID: PMC8131297 DOI: 10.1007/s11060-021-03747-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/23/2021] [Indexed: 12/14/2022]
Abstract
Introduction AEDs have been associated with depression, anxiety, and cognitive impairment, all frequent complications of glioma and its subsequent treatment, with considerable morbidity and an adverse effect on health-related quality of life. This study aimed to determine the independent association between AED use and self-reported depression, anxiety, and subjective cognitive impairment in glioma patients. Methods In this multicenter cross-sectional study, depression and anxiety were assessed with the HADS and subjective cognitive impairment was assessed with the MOS-CFS. Univariable logistic regression analyses were performed on all potential confounding predictor variables. Potential confounders were included in the multivariable analyses if p-value < 0.1, to evaluate whether use of AEDs was independently related to depression, anxiety, and/or subjective cognitive impairment. Results A total of 272 patients were included. Prevalence of depression differed significantly between patients not using (10%) and using AEDs (21%, unadjusted Odds Ratio [uOR] = 2.29 [95%CI 1.05–4.97], p = 0.037), but after correction for confounders the statistical significant difference was no longer apparent (adjusted Odds Ratio [aOR] = 1.94 [95%CI 0.83–4.50], p = 0.125). Prevalences of anxiety (aOR = 1.17 [95%CI 0.59–2.29], p = 0.659) and subjective cognitive impairment (aOR = 0.83 [95%CI 0.34–2.04], p = 0.684) did not differ significantly before or after adjustment of confounders between patients not using (19% and 16%, respectively) and using AEDs (26% and 21%, respectively). Conclusions Our results indicate AED use was not independently associated with concurrent depression, anxiety, or subjective cognitive impairment in glioma patients. Alternative factors seem to have a greater contribution to the risk of developing neuropsychiatric symptoms in glioma patients. Supplementary Information The online version contains supplementary material available at 10.1007/s11060-021-03747-1.
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Affiliation(s)
- Pim B van der Meer
- Department of Neurology, Leiden University Medical Center, PO BOX 9600, Leiden, 2300 RC, The Netherlands.
| | - Johan A F Koekkoek
- Department of Neurology, Leiden University Medical Center, PO BOX 9600, Leiden, 2300 RC, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | | | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, PO BOX 9600, Leiden, 2300 RC, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, PO BOX 9600, Leiden, 2300 RC, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
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24
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van der Meer PB, Dirven L, Fiocco M, Vos MJ, Kouwenhoven MCM, van den Bent MJ, Taphoorn MJB, Koekkoek JAF. First-line antiepileptic drug treatment in glioma patients with epilepsy: Levetiracetam vs valproic acid. Epilepsia 2021; 62:1119-1129. [PMID: 33735464 PMCID: PMC8251728 DOI: 10.1111/epi.16880] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 12/13/2022]
Abstract
Objective This study aimed at estimating the cumulative incidence of antiepileptic drug (AED) treatment failure of first‐line monotherapy levetiracetam vs valproic acid in glioma patients with epilepsy. Methods In this retrospective observational study, a competing risks model was used to estimate the cumulative incidence of treatment failure, from AED treatment initiation, for the two AEDs with death as a competing event. Patients were matched on baseline covariates potentially related to treatment assignment and outcomes of interest according to the nearest neighbor propensity score matching technique. Maximum duration of follow‐up was 36 months. Results In total, 776 patients using levetiracetam and 659 using valproic acid were identified. Matching resulted in two equal groups of 429 patients, with similar covariate distribution. The cumulative incidence of treatment failure for any reason was significantly lower for levetiracetam compared to valproic acid (12 months: 33% [95% confidence interval (CI) 29%–38%] vs 50% [95% CI 45%–55%]; P < .001). When looking at specific reasons of treatment failure, treatment failure due to uncontrolled seizures was significantly lower for levetiracetam compared to valproic acid (12 months: 16% [95% CI 12%–19%] vs 28% [95% CI 23%–32%]; P < 0.001), but no differences were found for treatment failure due to adverse effects (12 months: 14% [95% CI 11%–18%] vs 15% [95% CI 11%–18%]; P = .636). Significance Our results suggest that levetiracetam may have favorable efficacy compared to valproic acid, whereas level of toxicity seems similar. Therefore, levetiracetam seems to be the preferred choice for first‐line AED treatment in patients with glioma.
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Affiliation(s)
- Pim B van der Meer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Marta Fiocco
- Department of Biomedical Data Sciences, Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands.,Mathematical Institute, Leiden University, Leiden, The Netherlands
| | - Maaike J Vos
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | | | | | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Johan A F Koekkoek
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
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25
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Canas N, Félix C, Silva V, Arraiolos A, Fernandez-Llimos F. Comparative 12-month retention rate, effectiveness and tolerability of perampanel when used as a first add-on or a late add-on treatment in patients with focal epilepsies: The COM-PER study. Seizure 2021; 86:109-115. [PMID: 33592505 DOI: 10.1016/j.seizure.2021.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/26/2021] [Accepted: 01/31/2021] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To compare the 12-month retention rate, effectiveness and tolerability of perampanel (PER) as a first or late add-on treatment in adult patients with focal-onset seizures (FOS), including focal to bilateral tonic-clonic seizures (FBTCS). METHODS This retrospective, observational, multicenter study was carried out in patients with FOS that received PER as a late add-on (n = 60), after failure of > 3 AEDs, and a group that received PER as a first add-on treatment (n = 21). RESULTS At 12 months, the retention (90.5 % vs. 48.3 %; p = 0.001), seizure-freedom (71.4 % vs. 13.3 %; p < 0.001) and responder (85.7 % vs. 28.3 %; p < 0.001) rates were significantly higher in the first add-on group compared with the late add-on group. In patients with FBTCS, the 12-month retention rate did not differ significantly between the first and late add-on groups (93.8 % vs. 66.7 %); however, seizure-freedom (81.2 % vs. 27.8 %; p = 0.002) and responder rate response (93.8 % vs. 44.4 %; p = 0.002) were significantly higher in the first add-on group. There were no significant differences in tolerability between the two groups, including in patients with FBTCS. Adverse events were reported in 54.3 % of patients (44/81), most were mild or moderate, with dizziness being the most frequent one. CONCLUSION Overall, retention rate and effectiveness at 12 months were significantly higher in patients taking PER as a first add-on than as a late add-on, and the tolerability of PER did not differ significantly between groups. PER demonstrated high effectiveness in patients with FBTCS, even as a late add-on treatment.
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Affiliation(s)
- Nuno Canas
- Hospital Beatriz Ângelo, Neurology Department, Loures, Portugal; Centro Hospitalar Lisboa Ocidental, Reference Center for Refractory Epilepsies, Neurology Department, Hospital Egas Moniz, Lisbon, Portugal; Hospital CUF Descobertas, Neurology Department, Lisbon, Portugal.
| | - Catarina Félix
- Centro Hospitalar e Universitário do Algarve, Neurology Department, Faro, Portugal
| | - Vanessa Silva
- Hospital Beatriz Ângelo, Neurology Department, Loures, Portugal
| | - Ana Arraiolos
- Hospital Beatriz Ângelo, Neurology Department, Loures, Portugal
| | - Fernando Fernandez-Llimos
- Laboratory of Pharmacology, Department of Drug Sciences, College of Pharmacy, University of Porto, Porto, Portugal
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26
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Zhang CQ, He BM, Hu ML, Sun HB. Risk of Valproic Acid-Related Tremor: A Systematic Review and Meta-Analysis. Front Neurol 2021; 11:576579. [PMID: 33384651 PMCID: PMC7769765 DOI: 10.3389/fneur.2020.576579] [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: 06/26/2020] [Accepted: 10/09/2020] [Indexed: 11/20/2022] Open
Abstract
Purpose: To evaluate the incidence and risk of tremor in patients treated with valproic aid (VPA) monotherapy. Methods: We searched the PubMed, Embase, and Cochrane Library databases to gather relevant data on tremor in patients taking VPA and other drugs and performed a meta-analysis using Stata15.1 software. Results: Twenty-nine randomized controlled trials (RCTs) met the inclusion criteria and were included in the meta-analysis. The overall incidence of tremor in patients receiving VPA therapy was 14% [OR = 0.14, 95% CI (0.10–0.17)]. The pooled estimate risk of tremor showed a significant difference between patients treated with VPA and all other drugs [OR = 5.40, 95% CI (3.22–9.08)], other antiepileptic drugs (AEDs) [OR = 5.78, 95% CI (3.18–10.50)], and other non-AEDs [OR = 4.77, 95% CI (1.55–14.72)]. Both a dose of <1,500 mg/d of VPA [included 500 mg/d: OR = 3.57, 95% CI (1.24–10.26), 500–999 mg/d: OR = 3.99, 95% CI (1.95–8.20), 1,000–1,499 mg/d: OR = 8.82, 95% CI (3.25–23.94)] and a VPA treatment duration of <12 m [included ≤ 3 months: OR = 3.06, 95% CI (1.16–8.09), 3–6 months: OR = 16.98, 95% CI (9.14–31.57), and 6–12 months: OR = 4.15, 95% CI (2.74–6.29)] led to a higher risk of tremor than did other drugs, as did higher doses and longer treatment times. Conclusion: Compared with other drugs, VPA led to a higher risk of tremor, and the level of risk was associated with the dose and duration of treatment.
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Affiliation(s)
- Chen Qi Zhang
- Department of Neurology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Bao Ming He
- Department of Neurology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Mei Ling Hu
- Department of Neurology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Hong Bin Sun
- Department of Neurology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
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Chen S, Yoshida S, Matsumoto R, Ikeda A, Kawakami K. Prescription patterns of antiepileptic drugs for adult patients with newly diagnosed focal epilepsy from 2006 to 2017 in Japan. Epilepsy Res 2021; 169:106503. [DOI: 10.1016/j.eplepsyres.2020.106503] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 10/22/2022]
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Neuberger EE, Carlson JJ, Veenstra DL. Cost-Effectiveness of Cannabidiol Adjunct Therapy versus Usual Care for the Treatment of Seizures in Lennox-Gastaut Syndrome. PHARMACOECONOMICS 2020; 38:1237-1245. [PMID: 32715412 DOI: 10.1007/s40273-020-00945-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Cannabidiol (CBD) is a novel therapy for the treatment of Lennox-Gastaut Syndrome (LGS), a rare, treatment-refractory epileptic encephalopathy. Two pivotal trials found CBD 20 mg/kg/day conferred a reduction from baseline in median drop seizure frequency of 44% and 42%, respectively, compared with 22% and 17%, respectively, in the usual care arms. No economic evaluations have been published to date. This analysis assessed the cost effectiveness of CBD adjunct therapy compared with usual care alone in LGS from the US payer perspective. METHODS We developed a lifetime horizon Markov decision analytic model. Efficacy, healthcare costs (2020 US$), and health state utilities were ascertained from published clinical trials, retrospective analyses, and time trade-off interviews conducted in the UK, respectively. Fifteen-year-old patients entering the model transitioned to states representing a percentage reduction in drop seizure frequency from baseline, where they remained until reverting back to baseline drop seizure frequency, or death. One-way and probabilistic sensitivity analyses were conducted to evaluate parameter uncertainty, and scenario analyses investigated the impact of various assumptions. Costs and outcomes were discounted at 3%. RESULTS Compared with usual care alone, CBD yielded 0.7 additional quality-adjusted life-years (QALYs) and $314,900 additional healthcare expenditure, resulting in $451,800 per QALY. Uncertainty in health state utilities were the largest contributor to uncertainty in the results. Results from the 5000-simulation probabilistic sensitivity analysis indicated a 0% chance of CBD being cost effective at a $150,000 per QALY willingness-to-pay threshold, with a 95% credible range for the incremental cost-effectiveness ratio of $325,300-$690,000 per QALY. CONCLUSION CBD does not appear to be a cost-effective therapeutic option in LGS patients at a willingness-to-pay threshold of $150,000/QALY.
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Affiliation(s)
- Edward E Neuberger
- Department of Pharmacy, The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA.
| | - Josh J Carlson
- Department of Pharmacy, The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA
| | - David L Veenstra
- Department of Pharmacy, The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA
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Li R, Zhou Q, Ou S, Wang Y, Li Y, Xia L, Pan S. Comparison of long-term efficacy, tolerability, and safety of oxcarbazepine, lamotrigine, and levetiracetam in patients with newly diagnosed focal epilepsy: An observational study in the real world. Epilepsy Res 2020; 166:106408. [DOI: 10.1016/j.eplepsyres.2020.106408] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/16/2020] [Accepted: 06/23/2020] [Indexed: 10/24/2022]
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Arnold S, Laloyaux C, Schulz AL, Elmoufti S, Yates S, Fakhoury T. Long-term safety and efficacy of brivaracetam in adults with focal seizures: Results from an open-label, multinational, follow-up trial. Epilepsy Res 2020; 166:106404. [DOI: 10.1016/j.eplepsyres.2020.106404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/15/2020] [Accepted: 06/20/2020] [Indexed: 10/24/2022]
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Sarangi SC, Kaur N, Tripathi M. Need for pharmacoeconomic consideration of antiepileptic drugs monotherapy treatment in persons with epilepsy. Saudi Pharm J 2020; 28:1228-1237. [PMID: 33132717 PMCID: PMC7584808 DOI: 10.1016/j.jsps.2020.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 08/18/2020] [Indexed: 11/16/2022] Open
Abstract
Objective Newer antiepileptic drugs (AEDs) are expected to have less adverse effects (AEs) and drug interactions as compared to conventional AEDs but the high cost is the major limitation for their use. This study evaluated variation in the cost of treatment with newer and conventional AEDs through its correlation with treatment efficacy and AEs in persons with epilepsy (PWE). Methods This cross-sectional study included PWE (28.9 ± 9.9 years) having focal and generalized seizures on conventional [valproate, carbamazepine, phenytoin] or newer AEDs [levetiracetam, oxcarbazepine] for >6 months. Seizure frequency during the study (6 months) was compared to that within 6 months before the study. Other parameters assessed were Quality of life in epilepsy, Pittsburgh Sleep Quality Index, Gastrointestinal Quality of life Index, and Liverpool AEs Profile. The cost of treatment was determined as direct, indirect, and intangible costs. The incremental cost-effectiveness ratio (ICER) analysis was also performed. Results Out of 214 PWE, 51.4% were on newer AEDs. Newer and conventional AEDs did not differ significantly in seizure frequency reduction (60.29 vs. 53.09%), quality of life parameters, though these were improved significantly during the study period. The direct medical cost and total cost of treatment were lesser with conventional AEDs (p < 0.001 in both) than newer AEDs, but the intangible cost did not differ. The total cost of treatment was significantly influenced by factors (as per regression analysis) including the type of AEDs (significant difference between valproate, carbamazepine, and levetiracetam), frequency of seizures, cost of medicine (70.34% of total cost), hospital admission, and treatment of AEs. As per ICER, newer AEDs need an additional USD 8.39 per unit reduction in seizure frequency. Conclusion Newer AEDs have comparatively better efficacy, though not significant than conventional AEDs. However, the additional cost per unit improvement is quite high with newer AEDs, necessitating pharmacoeconomic consideration in epilepsy treatment.
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Affiliation(s)
- Sudhir C Sarangi
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Nivendeep Kaur
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Visa-Reñé N, Raspall-Chaure M, Paredes-Carmona F, Coromina JS, Macaya-Ruiz A. Clinical experience with brivaracetam in a series of 46 children. Epilepsy Behav 2020; 107:107067. [PMID: 32302941 DOI: 10.1016/j.yebeh.2020.107067] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/16/2020] [Accepted: 03/22/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The primary objective of the study was to analyze the efficacy of brivaracetam (BRV) in pediatric patients 12 months after starting treatment. The secondary objective was to establish safety 3, 6, and 12 months after starting treatment. MATERIALS AND METHOD This was an observational and retrospective study. Data were collected from the electronic medical record. Inclusion criteria were as follows: patients under 18 years of age, diagnosis of focal or generalized epilepsy, treatment as an added therapy, initiation of treatment with BRV between June and September 2017, and at least one unprovoked seizure in the year prior to the start of treatment. RESULTS Forty-six patients were included. The response rate was 65%, including 30% seizure-free patients. The rate of adverse effects was 43.5%, resulting in withdrawal in 16 patients (34.7%). The most common adverse effects were drowsiness (17.3%) and irritability (17.3%). CONCLUSIONS Brivaracetam is effective in very diverse childhood epilepsies, including some that present with primarily generalized seizures. Given the characteristics of the population studied, we have not been able to confirm a better tolerability of BRV compared with levetiracetam (LEV).
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Affiliation(s)
- Núria Visa-Reñé
- Paediatric Department, Hospital Universitari Arnau de Vilanova [Arnau de Vilanova University Hospital], Lleida, Spain.
| | - Miquel Raspall-Chaure
- Paediatric Neurology Department, Hospital Materno-Infantil Vall d'Hebron [Vall d'Hebron Maternity-Neonatal Hospital], Barcelona, Spain
| | - Fernando Paredes-Carmona
- Paediatric Department, Hospital Universitari Arnau de Vilanova [Arnau de Vilanova University Hospital], Lleida, Spain
| | - Júlia Sala Coromina
- Paediatric Neurology Department, Hospital Materno-Infantil Vall d'Hebron [Vall d'Hebron Maternity-Neonatal Hospital], Barcelona, Spain
| | - Alfons Macaya-Ruiz
- Paediatric Neurology Department, Hospital Materno-Infantil Vall d'Hebron [Vall d'Hebron Maternity-Neonatal Hospital], Barcelona, Spain
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Kundap UP, Paudel YN, Shaikh MF. Animal Models of Metabolic Epilepsy and Epilepsy Associated Metabolic Dysfunction: A Systematic Review. Pharmaceuticals (Basel) 2020; 13:ph13060106. [PMID: 32466498 PMCID: PMC7345684 DOI: 10.3390/ph13060106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 12/13/2022] Open
Abstract
Epilepsy is a serious neurological disorder affecting around 70 million people globally and is characterized by spontaneous recurrent seizures. Recent evidence indicates that dysfunction in metabolic processes can lead to the alteration of neuronal and network excitability, thereby contributing to epileptogenesis. Developing a suitable animal model that can recapitulate all the clinical phenotypes of human metabolic epilepsy (ME) is crucial yet challenging. The specific environment of many symptoms as well as the primary state of the applicable neurobiology, genetics, and lack of valid biomarkers/diagnostic tests are the key factors that hinder the process of developing a suitable animal model. The present systematic review summarizes the current state of available animal models of metabolic dysfunction associated with epileptic disorders. A systematic search was performed by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model. A range of electronic databases, including google scholar, Springer, PubMed, ScienceDirect, and Scopus, were scanned between January 2000 and April 2020. Based on the selection criteria, 23 eligible articles were chosen and are discussed in the current review. Critical analysis of the selected literature delineated several available approaches that have been modeled into metabolic epilepsy and pointed out several drawbacks associated with the currently available models. The result describes available models of metabolic dysfunction associated with epileptic disorder, such as mitochondrial respiration deficits, Lafora disease (LD) model-altered glycogen metabolism, causing epilepsy, glucose transporter 1 (GLUT1) deficiency, adiponectin responsive seizures, phospholipid dysfunction, glutaric aciduria, mitochondrial disorders, pyruvate dehydrogenase (PDH) α-subunit gene (PDHA1), pyridoxine dependent epilepsy (PDE), BCL2-associated agonist of cell death (BAD), Kcna1 knock out (KO), and long noncoding RNAs (lncRNA) cancer susceptibility candidate 2 (lncRNA CASC2). Finally, the review highlights certain focus areas that may increase the possibilities of developing more suitable animal models and underscores the importance of the rationalization of animal models and evaluation methods for studying ME. The review also suggests the pressing need of developing precise robust animal models and evaluation methods for investigating ME.
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Affiliation(s)
- Uday Praful Kundap
- Research Center of the University of Montreal Hospital Center (CRCHUM), Department of Neurosciences, Université de Montréal, Montréal, QC H2X 0A9, Canada; (U.P.K.); (Y.N.P.)
- Neuropharmacology Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor 47500, Malaysia
| | - Yam Nath Paudel
- Research Center of the University of Montreal Hospital Center (CRCHUM), Department of Neurosciences, Université de Montréal, Montréal, QC H2X 0A9, Canada; (U.P.K.); (Y.N.P.)
| | - Mohd. Farooq Shaikh
- Neuropharmacology Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor 47500, Malaysia
- Correspondence: ; Tel.: +60-3-551-44-483
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Menzler K, Mross PM, Rosenow F, Schubert-Bast S, Willems LM, Zahnert F, Immisch I, Fuest S, von Podewils F, Kunz R, Hirsch M, Mueller T, Marquetand J, Winter Y, Langenbruch L, Cicanic M, Beyenburg S, Strzelczyk A, Knake S. First clinical postmarketing experiences in the treatment of epilepsies with brivaracetam: a retrospective observational multicentre study. BMJ Open 2019; 9:e030746. [PMID: 31690606 PMCID: PMC6858140 DOI: 10.1136/bmjopen-2019-030746] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Brivaracetam (BRV) is the latest approved antiepileptic drug and acts as a synaptic vesicle protein 2A ligand. The aim of the present study was to evaluate the efficacy and tolerability of BRV in the clinical setting. DESIGN Retrospective, observational multicentre study. SETTING We retrospectively collected clinical data of patients who received BRV in 10 epilepsy centres using a questionnaire that was answered by the reporting neurologist. PARTICIPANTS Data of 615 epilepsy patients treated with BRV were included in the study. PRIMARY AND SECONDARY OUTCOME MEASURES Efficacy regarding seizure frequency and tolerability of BRV were evaluated. Descriptive statistics complemented by X2 contingency tests and effect sizes were performed. RESULTS Overall, 44% of the patients had a decreased, 38% a stable and 18% an increased seizure frequency. 17% of patients achieved seizure freedom after initiation of BRV. The seizure frequency decreased in 63% of 19 patients with BRV monotherapy. 27% reported adverse effects, but only 10% of patients with monotherapy. Brivaracetam was significantly more often associated with decreased seizure frequency in levetiracetam (LEV) naïve patients (p=0.012), but BRV also led to a decreased seizure frequency in 42% of patients who had been treated with LEV before, including 17% of patients who were completely seizure free. Adverse effects under LEV improved in 62% and deteriorated in 2% of patients after the switch to BRV. At latest follow-up (mean±SD = 26.3±6.5 months), 68% were still on BRV. CONCLUSIONS The present study shows that results of the phase III studies on BRV match data from real life clinical settings. Brivaracetam seems to be a useful alternative in patients who have suffered adverse effects while taking LEV.
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Affiliation(s)
- Katja Menzler
- Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Peter Michael Mross
- Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Felix Rosenow
- Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Center of Neurology and Neurosurgery, University Hospital, Goethe-University Frankfurt, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER)
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Center of Neurology and Neurosurgery, University Hospital, Goethe-University Frankfurt, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER)
- Department of Child Neurology, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Laurent Maximilian Willems
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Center of Neurology and Neurosurgery, University Hospital, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Felix Zahnert
- Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Ilka Immisch
- Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Sven Fuest
- Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Felix von Podewils
- Epilepsy Center Greifswald and Department of Neurology, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Rhina Kunz
- Epilepsy Center Greifswald and Department of Neurology, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Martin Hirsch
- Epilepsy Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tamara Mueller
- Epilepsy Center Erlangen, Department of Neurology, University of Erlangen, Erlangen, Germany
| | - Justus Marquetand
- Epilepsy Center Tuebingen, Department of Neurology, University Hospital Tuebingen, Tuebingen, Germany
| | - Yaroslav Winter
- Epilepsy Center Mainz, Department of Neurology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Lisa Langenbruch
- Department of Neurology, University of Münster, Münster, Germany
| | - Michal Cicanic
- Sächsisches Epilepsiezentrum Radeberg gGmbH, Kleinwachau, Germany
| | | | - Adam Strzelczyk
- Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Center of Neurology and Neurosurgery, University Hospital, Goethe-University Frankfurt, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER)
| | - Susanne Knake
- Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Center for Personalized Translational Epilepsy Research (CePTER)
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Risk factors predisposing to psychotic symptoms during levetiracetam therapy: A retrospective study. Epilepsy Behav 2019; 100:106344. [PMID: 31525554 DOI: 10.1016/j.yebeh.2019.05.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE While levetiracetam (LEV) usage is a known risk factor for psychosis in epilepsy, the modulating effect of certain patient and treatment characteristics on the risk of psychosis has yet to be fully elucidated. METHODS In our tertiary epilepsy center, 84 patients with psychotic symptoms during LEV usage and 100 controls without psychotic symptoms during LEV usage were selected. Patient records were reviewed including demographics, medical history, antiepileptic drug use, and cognitive abilities. Univariate comparisons were performed, and variables with p < 0.1 were selected for binary logistic regression analysis. RESULTS The total incidence of psychosis during LEV therapy in our population was 3.7%. The timing of psychotic symptoms was classified as postictal in 20 (19.8%), interictal in 14 (15.4%), postepilepsy surgery in 1 (1.1%), and unknown in 18 cases (19.8%). In 31 cases (34.1%), psychotic symptoms were classified as an antiepileptic drug-induced psychotic disorder (AIPD) as a result of LEV. In 7 cases (7.7%), AIPD occurred as a result of a different antiepileptic drug. A significant association was found between the experience of psychotic symptoms and status epilepticus (p = 0.002), a history of psychotic symptoms (p < 0.000), a history of psychiatric illness other than psychosis (p = 0.010), and concomitant phenytoin (PHT) usage (p = 0.044). Cotherapy with lamotrigine (LTG) was protective (p = 0.042). A separate analysis of controls and exclusively the 31 cases with LEV-induced AIPD yielded comparable results; a significant association was confirmed with status epilepticus (p = 0.021) and history of psychotic symptoms (p = 0.018), as well as with female gender (p = 0.047) and intellectual disability (p = 0.043). CONCLUSION Our retrospective study found that psychotic symptoms during LEV therapy were significantly associated with status epilepticus, a history of psychotic symptoms, a history of psychiatric illness other than psychosis, and concomitant PHT usage, whereas concomitant LTG usage was protective. Psychotic symptoms specifically as an adverse drug reaction to LEV were significantly associated with female gender, intellectual disability, status epilepticus, and a history of psychotic symptoms.
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Steinhoff BJ, Staack AM. Levetiracetam and brivaracetam: a review of evidence from clinical trials and clinical experience. Ther Adv Neurol Disord 2019; 12:1756286419873518. [PMID: 31523280 PMCID: PMC6734620 DOI: 10.1177/1756286419873518] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/12/2019] [Indexed: 01/15/2023] Open
Abstract
Until the early 1990s, a limited number of antiepileptic drugs (AEDs) were available. Since then, a large variety of new AEDs have been developed and introduced, several of them offering new modes of action. One of these new AED families is described and reviewed in this article. Levetiracetam (LEV) and brivaracetam (BRV) are pyrrolidone derivate compounds binding at the presynaptic SV2A receptor site and are thus representative of AEDs with a unique mode of action. LEV was extensively investigated in randomized controlled trials and has a very promising efficacy both in focal and generalized epilepsies. Its pharmacokinetic profile is favorable and LEV does not undergo clinically relevant interactions. Adverse reactions comprise mainly asthenia, somnolence, and behavioral symptoms. It has now been established as a first-line antiepileptic drug. BRV has been recently introduced as an adjunct antiepileptic drug in focal epilepsy with a similarly promising pharmacokinetic profile and possibly increased tolerability concerning psychiatric adverse events. This review summarizes the essential preclinical and clinical data of LEV and BRV that is currently available and includes the experiences at a large tertiary referral epilepsy center.
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Oster JM. Brivaracetam: a newly approved medication for epilepsy. FUTURE NEUROLOGY 2019. [DOI: 10.2217/fnl-2015-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Brivaracetam (BRV) in both the USA and EU was developed as a novel molecule for the adjunctive treatment of partial-onset (focal) seizures in patients ≥16 years of age and as of September 2017 was approved for use as monotherapy in the USA uniquely as an antiseizure medication that may be prescribed without a dose finding uptitration. This article reviews BRV's pharmacology, efficacy, safety and adverse event profiles, along with the relevant and noted regulatory hurdles in the USA and the EU. Available postmarketing data will also be summarized. Approximately 3000 patients were studied over about 9 years in the clinical trial program illustrating that BRV has efficacy at 50–200 mg/day with an acceptable adverse event profile.
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Affiliation(s)
- Joel M Oster
- Department of Neurology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA
- Lahey Clinic, Burlington, MA 02111, USA
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Lee SK, Lee SA, Kim DW, Loesch C, Pelgrims B, Osakabe T, Lee B. A randomized, open-label, multicenter comparative trial of levetiracetam and topiramate as adjunctive treatment for patients with focal epilepsy in Korea. Epilepsy Behav 2019; 97:67-74. [PMID: 31195326 DOI: 10.1016/j.yebeh.2019.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this trial was to compare the effectiveness of levetiracetam (LEV) and topiramate (TPM) as adjunctive treatment for patients with focal seizures in Korea. METHODS In this Phase IV, open-label, multicenter trial (NCT01229735), adults were randomized to treatment with LEV (1000-3000 mg/day) or TPM (200-400 mg/day). Only patients achieving LEV ≥1000 mg/day or TPM ≥100 mg/day after a 4-week up-titration entered the 20-week dose-finding and subsequent 28-week maintenance periods. The primary outcome was the 52-week retention rate; others included safety and exploratory efficacy outcomes. RESULTS Of 343 randomized patients (LEV 177; TPM 166), 211 (61.5%) completed the trial. In the full analysis set (FAS), retention rate was 59.1% with LEV vs 56.6% with TPM (p = 0.7007), while in the prespecified sensitivity analysis, based on data from patients who received drug doses in the recommended range (LEV 176; TPM 113), it was 59.1% with LEV vs 42.5% with TPM (p = 0.0086). In the FAS, median percent reduction in seizure frequency from baseline was 74.47% with LEV and 67.86% with TPM (p = 0.0665); ≥50% responder rate was 69.0% vs 64.8% (p = 0.4205), and the 6-month seizure-freedom rate was 35.8% vs 22.3% (p = 0.0061). In the sensitivity analysis, differences between groups were greater, favoring LEV. Incidences of treatment-emergent adverse events (TEAEs) were 70.6% with LEV vs 77.1% with TPM; most frequently somnolence (20.3%), dizziness (18.1%), and nasopharyngitis (13.6%) with LEV; and decreased appetite (15.7%), dizziness (14.5%), and headache (14.5%) with TPM. Discontinuations due to TEAEs were 7.9% with LEV and 12.7% with TPM. CONCLUSIONS In this open-label trial, the 52-week retention rate was not significantly different between LEV and TPM. However, LEV was associated with a substantially higher seizure freedom rate and a more favorable safety profile than TPM in this population of Korean patients with focal seizures.
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Affiliation(s)
- Sang Kun Lee
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Ahm Lee
- University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | | | | | | | - Byungin Lee
- Injie University Haeundae Paik Hospital, Busan, Republic of Korea.
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Choo BKM, Kundap UP, Johan Arief MFB, Kumari Y, Yap JL, Wong CP, Othman I, Shaikh MF. Effect of newer anti-epileptic drugs (AEDs) on the cognitive status in pentylenetetrazol induced seizures in a zebrafish model. Prog Neuropsychopharmacol Biol Psychiatry 2019; 92:483-493. [PMID: 30844417 DOI: 10.1016/j.pnpbp.2019.02.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/13/2019] [Accepted: 02/24/2019] [Indexed: 12/30/2022]
Abstract
Epilepsy is marked by seizures that are a manifestation of excessive brain activity and is symptomatically treatable by anti-epileptic drugs (AEDs). Unfortunately, the older AEDs have many side effects, with cognitive impairment being a major side effect that affects the daily lives of people with epilepsy. Thus, this study aimed to determine if newer AEDs (Zonisamide, Levetiracetam, Perampanel, Lamotrigine and Valproic Acid) also cause cognitive impairment, using a zebrafish model. Acute seizures were induced in zebrafish using pentylenetetrazol (PTZ) and cognitive function was assessed using the T-maze test of learning and memory. Neurotransmitter and gene expression levels related to epilepsy as well as learning and memory were also studied to provide a better understanding of the underlying processes. Ultimately, impaired cognitive function was seen in AED treated zebrafish, regardless of whether seizures were induced. A highly significant decrease in γ-Aminobutyric Acid (GABA) and glutamate levels was also discovered, although acetylcholine levels were more variable. The gene expression levels of Brain-Derived Neurotrophic Factor (BDNF), Neuropeptide Y (NPY) and Cyclic Adenosine Monophosphate (CAMP) Responsive Element Binding Protein 1 (CREB-1) were not found to be significantly different in AED treated zebrafish. Based on the experimental results, a decrease in brain glutamate levels due to AED treatment appears to be at least one of the major factors behind the observed cognitive impairment in the treated zebrafish.
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Affiliation(s)
- Brandon Kar Meng Choo
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Uday P Kundap
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Muhammad Faiz Bin Johan Arief
- MBBS Young Scholars Program, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Yatinesh Kumari
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Jia Ling Yap
- School of Science, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Chee Piau Wong
- Royal College of Surgeons in Ireland School of Medicine, Perdana University, Kuala Lumpur, Malaysia
| | - Iekhsan Othman
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Mohd Farooq Shaikh
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia.
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Wang X, Wang H, Xu D, Zhu L, Liu L. Risk of valproic acid-related alopecia: A systematic review and meta-analysis. Seizure 2019; 69:61-69. [PMID: 30981051 DOI: 10.1016/j.seizure.2019.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSE We systematically reviewed studies to provide current evidence about the incidence and risk of alopecia in patients undergoing valproic acid (VPA) therapy. METHODS We retrieved relevant publications and gathered data on alopecia in patients taking VPA and other drugs from prospective studies. RESULTS Twenty-five articles met the inclusion criteria, and the overall incidence of alopecia in patients receiving VPA therapy was 11% (95% confidence interval (CI): 0.08-0.13). The pooled risk of alopecia showed a significant difference between patients treated with VPA and all other drugs (odds ratio (OR) 5.02, 95% CI: 3.58-7.03), other epileptic drugs (AEDs) (OR 4.82, 95% CI: 3.32-7.00) and other non-AEDs (OR 5.84, 95% CI: 2.67-12.81). Compared to other drugs, VPA increased the risk of alopecia both in patients with migraine headaches (OR 6.05, 95% CI: 2.89-12.63) and patients with epilepsy (OR 5.29, 95% CI: 3.53-7.92), and the increase risk was reported more frequently in patients with migraine. Both lower doses (OR 4.38, 95% CI: 2.32-8.25) and shorter treatments (OR 4.98, 95% CI: 2.41-10.25) with VPA posed a high risk of alopecia compared to other drugs, as did higher doses and longer treatment times. CONCLUSIONS Based on our findings, VPA was significantly associated with a risk of alopecia compared to other drugs, and the risk did not depend on the dose and treatment time.
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Affiliation(s)
- Xueping Wang
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
| | - Haijiao Wang
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
| | - Da Xu
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
| | - Lina Zhu
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
| | - Ling Liu
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
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Reimers A, Ljung H. An evaluation of zonisamide, including its long-term efficacy, for the treatment of focal epilepsy. Expert Opin Pharmacother 2019; 20:909-915. [DOI: 10.1080/14656566.2019.1595584] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Arne Reimers
- Department of Clinical Chemistry and Pharmacology, Division of Laboratory Medicine, Lund, Sweden
| | - Hanna Ljung
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
- Department of Clinical Neurosciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
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Rüegger AD, Freeman JL, Harvey AS. Lacosamide in children with drug-resistant epilepsy. J Paediatr Child Health 2019; 55:194-198. [PMID: 30051539 DOI: 10.1111/jpc.14156] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/20/2018] [Accepted: 07/03/2018] [Indexed: 12/11/2022]
Abstract
AIM To assess the effectiveness and tolerability of lacosamide in paediatric clinical practice. METHODS A search of our hospital's pharmacy database yielded all children <16 years old dispensed lacosamide for drug-resistant epilepsy between January 2011 and June 2016. Medical records were reviewed for clinical and drug details. Continued treatment for ≥12 months was considered an indicator of effectiveness and tolerability. RESULTS A total of 107 children (61 boys) satisfied inclusion criteria. Median age at lacosamide commencement was 9.9 years (interquartile range 6.7-13.7). Of those children, 57 (53%) children had focal epilepsy, with focal motor or impaired awareness seizures most commonly reported; 50 (47%) children had generalised epilepsy, most with tonic-clonic seizures, tonic seizures or epileptic spasms; 83 (78%) children had an intellectual disability, 24 (22%) had a physical disability and 22 (21%) had an autism spectrum disorder; 69 (65%) children continued lacosamide for ≥12 months. Reasons for discontinuation before 12 months in 38 (35%) children included ineffectiveness in 25 (66%), adverse events in 7 (18%) and worsening of seizures in 2 (5%). The most common adverse events were drowsiness, behavioural changes, unsteadiness, nausea and vomiting. Epilepsy type and comorbidities were not associated with continuation or reasons for discontinuation. CONCLUSIONS Most children continued treatment with lacosamide, suggesting effectiveness and tolerability. Lacosamide may prove to be a useful, 'broad-spectrum' antiepileptic medication in children for focal and generalised epilepsies and in association with comorbidities.
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Affiliation(s)
- Andrea D Rüegger
- Department of Neurology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jeremy L Freeman
- Department of Neurology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - A Simon Harvey
- Department of Neurology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Rudakova IG, Belova YA, Kotov AS, Romanova MV. [A retrospective analysis of using zonisamide and retention in monotherapy among patients with epilepsy in routine clinical practice]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:80-87. [PMID: 32207736 DOI: 10.17116/jnevro201911911280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Zonisamide is one of the first antiepileptic drugs of new generation with a wide spectrum of action. It is successfully used in treatment of epilepsy for 30 years. The study aims at analyzing the results of the multicenter Russian trial on the efficacy and tolerability of zonisamide and retention in monotherapy. MATERIAL AND METHODS The analysis included 92 patients with focal epilepsy, aged 18-78 years, from 20 epileptology centers in different regions of Russia. The patients were treated with zonisamide in initial and subsequent treatment. RESULTS AND CONCLUSION The efficacy (the reduction of seizure frequency by >50%) was achieved in 81 (91%) out of 89 patients (95% CI 83.6-95.7%). Fifty-two patients received zonisamide for more than one year. The efficacy was achieved in 50 (96.2%) (95% CI 88.2-99.2%), including 39 (79.6%) patients with remission out of 49 patients with assessment of seizure free periods (95% CI was 66.8-89% for the frequency of remissions). The adverse effects were recorded in 27 (29.3%) patients. Seven (7.6%) patients were withdrawn due to these effects. The maximal duration of observation period was 50 month. Mean time of retention in treatment was 42.4 month (95% CI 38.7-46.2 month). The total frequency of retention in treatment was 82.1% (95% CI 73.1-91%) during the whole observation period.
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Affiliation(s)
- I G Rudakova
- Vladimirsky Moscow Regional Clinical and Research Institute, Moscow, Russia
| | - Yu A Belova
- Vladimirsky Moscow Regional Clinical and Research Institute, Moscow, Russia
| | - A S Kotov
- Vladimirsky Moscow Regional Clinical and Research Institute, Moscow, Russia
| | - M V Romanova
- Vladimirsky Moscow Regional Clinical and Research Institute, Moscow, Russia
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Mechanisms Underlying Aggressive Behavior Induced by Antiepileptic Drugs: Focus on Topiramate, Levetiracetam, and Perampanel. Behav Neurol 2018; 2018:2064027. [PMID: 30581496 PMCID: PMC6276511 DOI: 10.1155/2018/2064027] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/30/2018] [Indexed: 12/28/2022] Open
Abstract
Antiepileptic drugs (AEDs) are effective against seizures, but their use is often limited by adverse effects, among them psychiatric and behavioral ones including aggressive behavior (AB). Knowledge of the incidence, risk factors, and the underlying mechanisms of AB induced by AEDs may help to facilitate management and reduce the risk of such side effects. The exact incidence of AB as an adverse effect of AEDs is difficult to estimate, but frequencies up to 16% have been reported. Primarily, levetiracetam (LEV), perampanel (PER), and topiramate (TPM), which have diverse mechanisms of action, have been associated with AB. Currently, there is no evidence for a specific pharmacological mechanism solely explaining the increased incidence of AB with LEV, PER, and TPM. Serotonin (5-HT) and GABA, and particularly glutamate (via the AMPA receptor), seem to play key roles. Other mechanisms involve hormones, epigenetics, and “alternative psychosis” and related phenomena. Increased individual susceptibility due to an underlying neurological and/or a mental health disorder may further explain why people with epilepsy are at an increased risk of AB when using AEDs. Remarkably, AB may occur with a delay of weeks or months after start of treatment. Information to patients, relatives, and caregivers, as well as sufficient clinical follow-up, is crucial, and there is a need for further research to understand the complex relationship between AED mechanisms of action and the induction/worsening of AB.
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45
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Willems LM, Bertsche A, Bösebeck F, Hornemann F, Immisch I, Klein KM, Knake S, Kunz R, Kurlemann G, Langenbruch L, Möddel G, Müller-Schlüter K, von Podewils F, Reif PS, Steinhoff BJ, Steinig I, Rosenow F, Schubert-Bast S, Strzelczyk A. Efficacy, Retention, and Tolerability of Brivaracetam in Patients With Epileptic Encephalopathies: A Multicenter Cohort Study From Germany. Front Neurol 2018; 9:569. [PMID: 30083127 PMCID: PMC6064736 DOI: 10.3389/fneur.2018.00569] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/25/2018] [Indexed: 01/10/2023] Open
Abstract
Objective: To evaluate the efficacy and tolerability of brivaracetam (BRV) in a severely drug refractory cohort of patients with epileptic encephalopathies (EE). Method: A multicenter, retrospective cohort study recruiting all patients treated with EE who began treatment with BRV in an enrolling epilepsy center between 2016 and 2017. Results: Forty-four patients (27 male [61%], mean age 29 years, range 6 to 62) were treated with BRV. The retention rate was 65% at 3 months, 52% at 6 months and 41% at 12 months. A mean retention time of 5 months resulted in a cumulative exposure to BRV of 310 months. Three patients were seizure free during the baseline. At 3 months, 20 (45%, 20/44 as per intention-to-treat analysis considering all patients that started BRV including three who were seizure free during baseline) were either seizure free (n = 4; 9%, three of them already seizure-free at baseline) or reported at least 25% (n = 4; 9%) or 50% (n = 12; 27%) reduction in seizures. An increase in seizure frequency was reported in two (5%) patients, while there was no change in the seizure frequency of the other patients. A 50% long-term responder rate was apparent in 19 patients (43%), with two (5%) free from seizures for more than six months and in nine patients (20%, with one [2 %] free from seizures) for more than 12 months. Treatment-emergent adverse events were predominantly of psychobehavioural nature and were observed in 16%. Significance: In this retrospective analysis the rate of patients with a 50% seizure reduction under BRV proofed to be similar to those seen in regulatory trials for focal epilepsies. BRV appears to be safe and relatively well tolerated in EE and might be considered in patients with psychobehavioral adverse events while on levetiracetam.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
| | - Astrid Bertsche
- Department of Neuropediatrics, University of Rostock, Rostock, Germany.,Centre of Pediatric Research, Hospital for Children and Adolescents, Leipzig, Germany
| | - Frank Bösebeck
- Epilepsy Center Rotenburg, Agaplesion Diakonieklinikum Rotenburg, Rotenburg, Germany
| | - Frauke Hornemann
- Centre of Pediatric Research, Hospital for Children and Adolescents, Leipzig, Germany
| | - Ilka Immisch
- Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
| | - Karl M Klein
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
| | - Susanne Knake
- Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
| | - Rhina Kunz
- Epilepsy Center Greifswald and Department of Neurology, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Gerhard Kurlemann
- Department of Neuropediatrics, Westfälische Wilhelms-University, Münster, Germany
| | - Lisa Langenbruch
- Epilepsy Center Münster-Osnabrück, Department of Neurology with Institute of Translational Neurology - Epileptology, Westfälische Wilhelms-University, Münster, Germany
| | - Gabriel Möddel
- Epilepsy Center Münster-Osnabrück, Department of Neurology with Institute of Translational Neurology - Epileptology, Westfälische Wilhelms-University, Münster, Germany
| | - Karen Müller-Schlüter
- Epilepsy Center for Children, University Hospital Neuruppin, Brandenburg Medical School, Neuruppin, Germany
| | - Felix von Podewils
- Epilepsy Center Greifswald and Department of Neurology, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Philipp S Reif
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
| | | | - Isabel Steinig
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany.,Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany.,Department of Neuropediatrics, Goethe University Frankfurt, Frankfurt, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany.,Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
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Pharmacokinetic Factors to Consider in the Selection of Antiseizure Drugs for Older Patients with Epilepsy. Drugs Aging 2018; 35:687-698. [DOI: 10.1007/s40266-018-0562-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Qin J, Wang Y, Huang XF, Zhang YQ, Fang F, Chen YB, Lin ZD, Deng YC, Yin F, Jiang L, Wu Y, Hu XS. Oxcarbazepine oral suspension in young pediatric patients with partial seizures and/or generalized tonic-clonic seizures in routine clinical practice in China: a prospective observational study. World J Pediatr 2018; 14:280-289. [PMID: 29464579 DOI: 10.1007/s12519-017-0114-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/17/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aimed to assess efficacy and safety of oxcarbazepine (OXC) oral suspension in pediatric patients aged 2-5 years with partial seizures (PS) and/or generalized tonic-clonic seizures (GTCS) in real-world clinical practice in China. METHODS This 26-week, prospective, single-arm, multicenter, observational study recruited pediatric patients aged 2-5 years with PS or GTCS suitable for OXC oral suspension treatment based on physicians' judgments from 11 medical centers in China. Enrolled subjects started OXC oral suspension treatment as monotherapy or in combination with other antiepileptic drugs. Primary efficacy outcome was the percentage of pediatric subjects achieving ≥ 50% seizure frequency reduction at the end of the 26-week treatment. Secondary efficacy-related parameters and safety parameters such as adverse events (AEs) and serious AEs (SAEs) were also monitored during the 26-week treatment period. RESULTS Six hundred and six pediatric patients were enrolled and 531 (87.6%) completed the study. After 26 weeks of treatment, 93.3% subjects achieved ≥ 50% seizure frequency reduction, and 81.8% achieved 100% seizure frequency reduction compared to baseline. Among different seizure types, OXC was effective in all subjects with simple PS and in > 90% of subject with other type of seizure present in the study. AEs were observed in 49 (8.1%) subjects. Only three subjects experienced SAE. Rash (n = 18, 2.97%) was the most common AE. Only 17 subjects discontinued due to AEs. CONCLUSION This study, reporting the real-world data, further confirms the efficacy and good safety profile of OXC oral suspension in Chinese pediatric patients aged 2-5 years with PS and/or GTCS.
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Affiliation(s)
- Jiong Qin
- Department of Pediatrics, Peking University People's Hospital, No. 11 Xi Zhi Men Nan Da Jie, Xicheng District, Beijing, 100044, China.
- Department of Pediatrics, Peking University First Hospital, Beijing, China.
| | - Yi Wang
- Department of Neurology, Children's Hospital, Fudan University, Shanghai, China
| | - Xin-Fang Huang
- Department of Pediatrics, Quanzhou Women's and Children's Hospital, Quanzhou, China
| | - Yu-Qin Zhang
- Department of Neurology, Tianjin Children's Hospital, Tianjin, China
| | - Fang Fang
- Department of Neurology, Beijing Children's Hospital, Beijing, China
| | - Yin-Bo Chen
- Department of Pediatric Neurology, The First Bethune Hospital, Jilin University, Changchun, China
| | - Zhong-Dong Lin
- Department of Pediatric Neurology, The 2nd Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yan-Chun Deng
- Department of Neurology, Xijing Hospital, Xi'an, China
| | - Fei Yin
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Li Jiang
- Department of Neurology, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Ye Wu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xiang-Shu Hu
- The third Department of Neurology, Guangdong 999 Brain Hospital, Guangzhou, China
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Zahnert F, Krause K, Immisch I, Habermehl L, Gorny I, Chmielewska I, Möller L, Weyand AM, Mross PM, Wagner J, Menzler K, Knake S. Brivaracetam in the Treatment of Patients with Epilepsy-First Clinical Experiences. Front Neurol 2018; 9:38. [PMID: 29467714 PMCID: PMC5808159 DOI: 10.3389/fneur.2018.00038] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/16/2018] [Indexed: 01/15/2023] Open
Abstract
Objectives To assess first clinical experiences with brivaracetam (BRV) in the treatment of epilepsies. Methods Data on patients treated with BRV from February to December 2016 and with at least one clinical follow-up were collected from electronic patient records. Data on safety and efficacy were evaluated retrospectively. Results In total, 93 patients were analyzed; 12 (12.9%) received BRV in monotherapy. The mean duration to follow-up was 4.85 months (MD = 4 months; SD = 3.63). Fifty-seven patients had more than one seizure per month at baseline and had a follow-up of more than 4 weeks; the rate of ≥50% responders was 35.1% (n = 20) in this group, of which five (8.8%) patients were newly seizure-free. In 50.5% (47/93), patients were switched from levetiracetam (LEV) to BRV, of which 43 (46.2%) were switched immediately. Adverse events (AE) occurred in 39.8%, with 22.6% experiencing behavioral and 25.8% experiencing non-behavioral AE. LEV-related AE (LEV-AE) were significantly reduced by switching to BRV. The discontinuation of BRV was reported in 26/93 patients (28%); 10 of those were switched back to LEV with an observed reduction of AE in 70%. For clinical reasons, 12 patients received BRV in monotherapy, 75% were seizure–free, and previous LEV-AE improved in 6/9 patients. BRV-related AE occurred in 5/12 cases, and five patients discontinued BRV. Conclusion BRV seems to be a safe, easy, and effective option in the treatment of patients with epilepsy, especially in the treatment of patients who have psychiatric comorbidities and might not be good candidates for LEV treatment. BRV broadens the therapeutic spectrum and facilitates personalized treatment.
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Affiliation(s)
- Felix Zahnert
- Department of Neurology, Universitätsklinikum Gießen und Marburg, Philipps University of Marburg, Marburg, Germany
| | - Kristina Krause
- Department of Neurology, Universitätsklinikum Gießen und Marburg, Philipps University of Marburg, Marburg, Germany
| | - Ilka Immisch
- Department of Neurology, Universitätsklinikum Gießen und Marburg, Philipps University of Marburg, Marburg, Germany
| | - Lena Habermehl
- Department of Neurology, Universitätsklinikum Gießen und Marburg, Philipps University of Marburg, Marburg, Germany
| | - Iris Gorny
- Department of Neurology, Universitätsklinikum Gießen und Marburg, Philipps University of Marburg, Marburg, Germany
| | - Izabella Chmielewska
- Department of Neurology, Universitätsklinikum Gießen und Marburg, Philipps University of Marburg, Marburg, Germany
| | - Leona Möller
- Department of Neurology, Universitätsklinikum Gießen und Marburg, Philipps University of Marburg, Marburg, Germany
| | - Anna M Weyand
- Department of Neurology, Universitätsklinikum Gießen und Marburg, Philipps University of Marburg, Marburg, Germany
| | - Peter M Mross
- Department of Neurology, Universitätsklinikum Gießen und Marburg, Philipps University of Marburg, Marburg, Germany
| | - Jan Wagner
- Department of Neurology, Universitätsklinikum Gießen und Marburg, Philipps University of Marburg, Marburg, Germany
| | - Katja Menzler
- Department of Neurology, Universitätsklinikum Gießen und Marburg, Philipps University of Marburg, Marburg, Germany
| | - Susanne Knake
- Department of Neurology, Universitätsklinikum Gießen und Marburg, Philipps University of Marburg, Marburg, Germany
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Abstract
OBJECTIVES Perampanel is a recently introduced antiepileptic drug (AED) with a unique action mechanism of noncompetitive and selective α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid antagonist. Because of delayed approval of perampanel in most Asian countries, there is limited information on the clinical usefulness of perampanel in the Asian population. We performed a retrospective analysis of retention rate, seizure outcome, and adverse events for perampanel treatment in South Korea. METHODS This was a retrospective, single-center, 1-year observational study. A total of 137 epilepsy patients (86 men, 51 women; age, 17-86 years) who were treated with perampanel as an adjunctive treatment were included. Perampanel was administered at a starting dose of 2 mg/d, and optimal-dose adjustments were made according to individual clinical responses. Efficacy and tolerability were analyzed during a 1-year follow-up. RESULTS The overall retention rate was 71.3% at the 6-month follow-up and 61.0% at the 1-year follow-up. Retention rates were similar between patients with 1 concomitant AED and those taking 2 or more concomitant AEDs. The most common adverse event was somnolence, followed by dullness and psychiatric reactions, and the presence of psychiatric comorbidity was significantly associated with the development of psychiatric adverse reactions. CONCLUSIONS We showed that the retention rate and adverse events for adjunctive perampanel treatment in the Korean population were comparable with those in Western countries. Our study also suggests that adjuvant perampanel treatment may be effective in patients taking a higher number of concomitant AEDs and that psychiatric comorbidity may be a risk factor for perampanel-induced psychiatric reactions.
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50
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Toledo M, Beale R, Evans JS, Steeves S, Elmoufti S, Townsend R, Whitesides J, Borghs S. Long-term retention rates for antiepileptic drugs: A review of long-term extension studies and comparison with brivaracetam. Epilepsy Res 2017; 138:53-61. [DOI: 10.1016/j.eplepsyres.2017.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/03/2017] [Accepted: 10/08/2017] [Indexed: 11/25/2022]
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