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Panda PK, Sharawat IK, Dawman L, Panda P, Kasinathan A, Rathaur VK. Efficacy and Tolerability of Lacosamide in Lennox–Gastaut Syndrome: A Systematic Review and Meta-analysis. J Neurosci Rural Pract 2022; 13:32-42. [PMID: 35110918 PMCID: PMC8803519 DOI: 10.1055/s-0041-1740580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose
Lennox–Gastaut syndrome (LGS) is one of the most difficult to treat childhood-onset epileptic encephalopathies. There is growing evidence that lacosamide is safe and efficacious in patients and adults with refractory epilepsy. However, the evidence regarding the efficacy of lacosamide in LGS is controversial so far. We aimed to evaluate the efficacy and tolerability of lacosamide in patients with LGS.
Methods
We conducted a systematic review on MEDLINE, EMBASE, COCHRANE CENTRAL, Google Scholar, and Web of Science, collating all available literature till July 31, 2020. The qualitative review included case reports, case series, and both controlled/uncontrolled trials as well as retrospective studies, but for determining pooled estimates, we only included studies with a sample size of 5 or more. The primary outcome was the efficacy of lacosamide in patients with LGS. Clinical variables related to efficacy and adverse events attributed to lacosamide were extracted from each publication. The pooled estimate of variables related to these parameters was performed using a random-effect model.
Results
Of the 68 items identified by the search, 14 were reviewed as full-text. Eleven articles including two prospective and six retrospective studies fulfilled eligibility criteria and described outcomes in 81 patients (42 adults, 39 children, 60% male, range—1.4–61 years). On average, 35.2%, 27.9%, 7.3%, and 29.4% patients had > 50% reduction, < 50% reduction, no change, and worsening of seizure frequency, respectively. Although 36% of patients had adverse events like somnolence, behavioral abnormalities including irritability, aggressiveness, nausea, tremor, memory problems, dizziness, gastrointestinal discomfort, vomiting, and weight loss, no serious adverse events were noted.
Conclusion
The evidence available in the current literature is not sufficient to support or refute the use of lacosamide in patients with LGS. Although it is one of the possible therapeutic options worth exploring in patients with LGS, caution is still necessary, as there are reports of worsening of seizure frequency in some patients.
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Affiliation(s)
- Prateek Kumar Panda
- Division of Pediatric Neurology, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Indar Kumar Sharawat
- Division of Pediatric Neurology, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Lesa Dawman
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pragnya Panda
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | | | - Vyas Kumar Rathaur
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Panda PK, Panda P, Dawman L, Sharawat IK. Efficacy of lacosamide and phenytoin in status epilepticus: A systematic review. Acta Neurol Scand 2021; 144:366-374. [PMID: 33999428 DOI: 10.1111/ane.13469] [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: 02/21/2021] [Revised: 04/14/2021] [Accepted: 05/02/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To compare the evidence on efficacy, safety, tolerability, and impact on short term/long functional outcome of lacosamide (LCM) and phenytoin (PHT) in patients with status epilepticus. MATERIALS & METHODS We conducted a systematic literature search of relevant electronic databases using a suitable search strategy to identify studies directly comparing PHT and LCM, irrespective of dose and duration in patients with convulsive and/or nonconvulsive status epilepticus (SE). We used a standardized assessment form to extract information on the study design, data sources, methodologic framework, efficacy, and adverse events attributed to PHT and LCM from included studies and compared the efficacy and safety outcomes, using a fixed/random effect model. RESULTS Five studies were found to be eligible for inclusion out of 192 search items, enrolling a total of 115 and 166 participants (predominantly with SE) in LCM and PHT arm, respectively. Baseline characteristics were comparable between both arms. The proportion with seizure control was comparable between both arms (57.3% in LCM vs. 45.7% in PHT arm, p = 0.28) and even in the subgroup analysis separately for convulsive and non-convulsive SE. Proportion with treatment-emergent adverse events (TEAE) were comparable in both (17.6% vs. 12.2%, p = 0.20), but serious adverse events (SAE) were higher in PHT arm (5.1% vs. 0.8%, p = 0.049). The proportion with all-cause mortality and survival with moderate-severe disability were comparable between both arms (p = 0.23 and 0.37, respectively). CONCLUSION LCM has comparable efficacy with fewer SAEs as compared to PHT for achieving seizure control in patients with SE.
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Affiliation(s)
- Prateek Kumar Panda
- Pediatric Neurology Division Department of Pediatrics All India Institute of Medical Sciences Rishikesh India
| | - Pragnya Panda
- Department of Pediatrics Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Lesa Dawman
- Department of Neurology King George Medical University Lucknow India
| | - Indar Kumar Sharawat
- Pediatric Neurology Division Department of Pediatrics All India Institute of Medical Sciences Rishikesh India
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Han J, Konno H, Sato T, Soloshonok VA, Izawa K. Tailor-made amino acids in the design of small-molecule blockbuster drugs. Eur J Med Chem 2021; 220:113448. [PMID: 33906050 DOI: 10.1016/j.ejmech.2021.113448] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 02/06/2023]
Abstract
The role of amino acids (AAs) in modern health industry is well-appreciated. Residues of individual AAs, or their chemical modifications, such as diamines and amino alcohols, are frequently found in the structures of modern pharmaceuticals. The goal of this review article, is to emphasize that, currently, tailor-made AAs serve as key structural features in many most successful pharmaceuticals, so-called blockbuster drugs. In the present article, we profile 14 small-molecule drugs, underscoring the breadth of structural variety of AAs applications in numerous therapeutic areas. For each compound, we provide spectrum of biological activity, medicinal chemistry discovery, and synthetic approaches.
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Affiliation(s)
- Jianlin Han
- Jiangsu Co-Innovation Center of Efficient Processing and Utilization of Forest Resources, College of Chemical Engineering, Nanjing Forestry University, Nanjing, 210037, Jiangsu, China
| | - Hiroyuki Konno
- Department of Biological Engineering, Graduate School of Science and Engineering, Yamagata University, Yonezawa, Yamagata, 992-8510, Japan
| | - Tatsunori Sato
- Hamari Chemicals Ltd., 1-19-40, Nankokita, Suminoe-ku, Osaka, 559-0034, Japan
| | - Vadim A Soloshonok
- Department of Organic Chemistry I, Faculty of Chemistry, University of the Basque Country UPV/EHU, Paseo Manuel Lardizábal 3, 20018, San Sebastián, Spain; IKERBASQUE, Basque Foundation for Science, María Díaz de Haro 3, Plaza Bizkaia, 48013, Bilbao, Spain.
| | - Kunisuke Izawa
- Hamari Chemicals Ltd., 1-19-40, Nankokita, Suminoe-ku, Osaka, 559-0034, Japan.
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Aratikatla EK, Bhattacharya AK. A Short Review of Synthetic Routes for the Antiepileptic Drug ( R)-Lacosamide. Org Process Res Dev 2020. [DOI: 10.1021/acs.oprd.9b00373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Eswar K. Aratikatla
- Division of Organic Chemistry, CSIR-National Chemical Laboratory (CSIR-NCL), Dr. Homi Bhabha Road, Pune-411 008, India
- Academy of Scientific and Innovative Research (AcSIR), CSIR-NCL, Pune-411 008, India
| | - Asish K. Bhattacharya
- Division of Organic Chemistry, CSIR-National Chemical Laboratory (CSIR-NCL), Dr. Homi Bhabha Road, Pune-411 008, India
- Academy of Scientific and Innovative Research (AcSIR), CSIR-NCL, Pune-411 008, India
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Abstract
Introduction: Lacosamide has been used in epilepsy patients in the United States, Europe and Asia since it was approved by the FDA in 2008. Many patients have benefited from this drug as a new generation of sodium channel blocker. With the worldwide use of this drug, its adverse effects have gradually emerged, especially some rare adverse events.Areas covered: The present review aims to summarize the adverse effects of lacosamide reported in the literature in recent years to promote the safe clinical application of the drug.Expert opinion: In more than 10 years of experience in drug usage, adverse reactions of lacosamide have also been gradually discovered. The review showed that lacosamide is safe and effective in antiepileptic treatment, and its common side effects are dizziness, headache, drowsiness, diplopia, and cardiovascular abnormalities. Skin rashes, hematotoxicity and heart damage, psychological symptoms and suicide risk have also been reported and emphasized.
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Affiliation(s)
- Jiyuan Li
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Meizhen Sun
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Xuefeng Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Yang A, Hu F, Li Z, Chen M, Cai J, Wang L, Zhang T, Zhao C, Zhang F. Improved Synthesis and Impurity Identification of (R)-Lacosamide. Org Process Res Dev 2019. [DOI: 10.1021/acs.oprd.8b00370] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Anjiang Yang
- Shanghai Institute of Pharmaceutical Industry, China State Institute of Pharmaceutical Industry, 285 Gebaini Road, Pudong District, Shanghai 201203, People’s Republic of China
| | - Feifei Hu
- Shanghai Institute of Pharmaceutical Industry, China State Institute of Pharmaceutical Industry, 285 Gebaini Road, Pudong District, Shanghai 201203, People’s Republic of China
| | - Zhong Li
- Shanghai Institute of Pharmaceutical Industry, China State Institute of Pharmaceutical Industry, 285 Gebaini Road, Pudong District, Shanghai 201203, People’s Republic of China
| | - Mengdi Chen
- Shanghai Institute of Pharmaceutical Industry, China State Institute of Pharmaceutical Industry, 285 Gebaini Road, Pudong District, Shanghai 201203, People’s Republic of China
- School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenhe District, Shenyang, Liaoning 110016, People’s Republic of China
| | - Jianguang Cai
- Department of Organic Process Research and Development, Zhejiang Hisun Pharmaceutical Company Limited, 46 Waisha Road,
Jiaojiang District, Taizhou, Zhejiang 318000, People’s Republic of China
| | - Linghui Wang
- Department of Organic Process Research and Development, Zhejiang Hisun Pharmaceutical Company Limited, 46 Waisha Road,
Jiaojiang District, Taizhou, Zhejiang 318000, People’s Republic of China
| | - Tao Zhang
- Shanghai Institute of Pharmaceutical Industry, China State Institute of Pharmaceutical Industry, 285 Gebaini Road, Pudong District, Shanghai 201203, People’s Republic of China
| | - Chuanmeng Zhao
- Shanghai Institute of Pharmaceutical Industry, China State Institute of Pharmaceutical Industry, 285 Gebaini Road, Pudong District, Shanghai 201203, People’s Republic of China
| | - Fuli Zhang
- Shanghai Institute of Pharmaceutical Industry, China State Institute of Pharmaceutical Industry, 285 Gebaini Road, Pudong District, Shanghai 201203, People’s Republic of China
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