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Xiong L, He H, Wang D, Liu T, Xiao N. Effectiveness and safety of Lacosamide in pediatric patients with epilepsy under four years: Results from a prospective cohort study in China. Seizure 2024; 118:71-79. [PMID: 38643678 DOI: 10.1016/j.seizure.2024.04.009] [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: 02/12/2024] [Revised: 03/25/2024] [Accepted: 04/09/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Lacosamide (LCM) has shown promising efficacy and safety outcomes in clinical trials. However, the evidence is limited among pediatric patients especially under four years in real-world. The study investigated the treatment outcomes and safety of LCM in patients under four years based on the data of the epilepsy registry of Children in China. METHODS A prospective cohort study was conducted among patients under 4 years who newly received LCM as monotherapy or adjunctive therapy. The treatment outcomes were measured by retention rate of LCM, 50 % response rates and seizure-free rates during follow-up. The retention rate of LCM was assessed using the Kaplan-Meier survival model. Adverse events were reported as a percentage of all participants. RESULTS Of 109 participants (mean follow-up: 18.6 months), 59 received LCM as monotherapy and 50 as adjunctive therapy. Sixty patients had focal epilepsy, 44 had generalized epilepsy and 5 had combined generalized and focal epilepsy. 70 % of patients in the monotherapy group and 41 % in the adjunctive therapy group remained on LCM treatment without additional treatments for at least one year. In patients with monotherapy, 50 % response rate and seizure-free rate were 75 % and 56 % at 12 months, respectively. In adjunctive therapy group, these rates were 51 % and 36 %, respectively. Lower baseline seizure frequency in both treatment groups (monotherapy: p < 0.001; adjunctive therapy: p = 0.02) and younger age groups within the monotherapy group (P = 0.04) correlated with a higher LCM retention rate. Adverse events were reported by 15 patients (13.8 %), with somnolence being the most common (7 of 15 patients). CONCLUSION With a comprehensive information and high-quality of data, the study demonstrates the effective treatment outcome and safety of LCM. The study adds reliable evidence to exiting real-word evidence of LCM in the specific age group of patients with epilepsy to fill the evidence gap.
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Affiliation(s)
- Li Xiong
- Department of Rehabilitation, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, No.136 Zhongshan Er Road, Yuzhong District, Chongqing 400000, China
| | - Huan He
- Department of Rehabilitation, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, No.136 Zhongshan Er Road, Yuzhong District, Chongqing 400000, China
| | - Duan Wang
- Department of Rehabilitation, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, No.136 Zhongshan Er Road, Yuzhong District, Chongqing 400000, China
| | - Tailin Liu
- Department of Rehabilitation, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, No.136 Zhongshan Er Road, Yuzhong District, Chongqing 400000, China
| | - Nong Xiao
- Department of Rehabilitation, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, No.136 Zhongshan Er Road, Yuzhong District, Chongqing 400000, China.
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Wakabayashi K, Osaka H, Yamagishi H, Kuwajima M, Ikeda T, Matsumoto A, Muramatsu K, Yamagata T. Investigation of the efficacy and adverse effects of lacosamide over 36 months. Epilepsy Behav 2023; 144:109227. [PMID: 37207404 DOI: 10.1016/j.yebeh.2023.109227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVE To evaluate the efficacy and retention rate of lacosamide (LCM) over 36 months as a treatment for children and adolescents with focal and generalized epilepsy based on a retrospective study. METHODS All patients prescribed LCM as monotherapy and add-on therapy between October 2016 and September 2019 at Jichi Children's Medical Center Tochigi were included in the study. The response rate, retention rate, and adverse effects were calculated. RESULTS A total of 126 (female, n = 73) patients of 1.3 to 34.9 years old (median age: 12.8 years; mean ± SD 13.2 ± 6.6 years) received LCM as monotherapy or add-on treatment for focal, generalized, and combined focal and generalized epilepsy. The response rate was 40.5% at 3 months, 40.5% at 6 months, 38.1% at 9 months, 35.7% at 12 months, 25.9% at 24 months, and 29.4% at 36 months. For 34 patients who were observable for 36 months, the retention rate was 70.6% at 3 months, but then gradually declined to 34.8% at 36 months. According to the number of concomitant anti-seizure medications (ASMs), the retention rate was higher in patients receiving <3 ASMs than in those receiving ≥3 ASMs at all observation points. The most common adverse effects were somnolence in 21 patients (16.7%) and dizziness in 5 patients (39.7%). CONCLUSION Our response rate was lower and our retention rate was higher in comparison to a previous study that observed patients over 36 months. Further prospective studies in children are required to confirm the response rate and retention rate in patients treated with LCM over 36 months.
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Affiliation(s)
- Kei Wakabayashi
- Department of Pediatrics, Jichi Medical University, Division of Human Genetics, Center for Molecular Medicine, Jichi Medical University, Japan.
| | - Hitoshi Osaka
- Department of Pediatrics, Jichi Medical University, Division of Human Genetics, Center for Molecular Medicine, Jichi Medical University, Japan.
| | - Hirokazu Yamagishi
- Department of Pediatrics, Jichi Medical University, Division of Human Genetics, Center for Molecular Medicine, Jichi Medical University, Japan
| | - Mari Kuwajima
- Department of Pediatrics, Jichi Medical University, Division of Human Genetics, Center for Molecular Medicine, Jichi Medical University, Japan
| | - Takahiro Ikeda
- Department of Pediatrics, Jichi Medical University, Division of Human Genetics, Center for Molecular Medicine, Jichi Medical University, Japan
| | - Ayumi Matsumoto
- Department of Pediatrics, Jichi Medical University, Division of Human Genetics, Center for Molecular Medicine, Jichi Medical University, Japan
| | - Kazuhiro Muramatsu
- Department of Pediatrics, Jichi Medical University, Division of Human Genetics, Center for Molecular Medicine, Jichi Medical University, Japan
| | - Takanori Yamagata
- Department of Pediatrics, Jichi Medical University, Division of Human Genetics, Center for Molecular Medicine, Jichi Medical University, Japan
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Pozzi M, Zanotta N, Epifanio R, Baldelli S, Cattaneo D, Clementi E, Zucca C. Lacosamide effectiveness and tolerability in patients with drug-resistant epilepsy and severe disability under polytherapy: Therapy optimization as emerging from an observational study. Epilepsy Behav 2022; 128:108598. [PMID: 35151192 DOI: 10.1016/j.yebeh.2022.108598] [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: 11/08/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We explored the efficacy and safety of lacosamide combined with inhibitors of fast-inactivated sodium channels or with other antiepileptic drugs, in patients with drug refractory focal epilepsy associated with intellectual or psychiatric disability. METHODS Observational study of lacosamide including the monitoring of lacosamide trough plasma levels and of electroencephalograms. RESULTS We followed up 44 patients from the start of lacosamide therapy for up to 3 years, with a clinical, electroencephalogram (EEG), and pharmacological follow-up. Median patients' age was 32.7 years, median age at epilepsy onset was 3.5 years. Intellectual disability was severe in 55.4% of the cohort and drug refractoriness was diagnosed in 88.6% of patients, who had predominantly focal seizures (80%). The severity of their epilepsy was suggested by the use of combined therapies with non-sodium blockers and sodium blockers in 75% of patients. Lacosamide was added to previous therapies and up-titrated to a median of 300 mg/d. Lacosamide add-on led to simplification of the previous drug regimen with a dose reduction in 87.9% of users of sodium blockers and in 66.7% of users of non-sodium blockers, and to withdrawal of previously administered sodium blockers in 48.5% users and non-sodium blockers in 47.6% users. Lacosamide was prescribed at lower doses in the presence of oxcarbazepine (p = 0.029), lamotrigine (p = 0.015), and topiramate (p < 0.001). Mean lacosamide plasma levels were 6.0 ± 2.4 mg/L; they were in linear correlation with the administered dose (R2 = 0.38, p < 0.001) and were influenced by the association with lamotrigine (p = 0.008), zonisamide (p = 0.012), and clobazam (p = 0.028). Lacosamide combination regimens led to an average reduction of 42% in baseline seizure frequency, with 50% patients reporting ≥50% seizure frequency reduction. Efficacy was directly correlated with lacosamide dose (R2 = 0.47, p < 0.001, B = 0.53) and trough plasma levels (R2 = 0.31, p < 0.001, B = 0.16). Electroencephalogram profiles were improved in 40.9% of patients and EEG improvement was not significantly correlated with seizure frequency reduction. Lacosamide safety was good, with 37 adverse reactions in 30 patients, of which 50% were attributed to lacosamide and led to lacosamide withdrawal in 18% of cases. The retention rate of lacosamide was of 88.6% at 1 year, 86.4% at 2 years, and 72.7% after three years. The severity of intellectual disability was directly correlated with increased possibility of lacosamide retention (OR = 0.46 per severity tier, p = 0.016). CONCLUSION Lacosamide add-on allowed dose reduction of previous therapies and reduced the frequency of seizures, showing good tolerability even at high doses, without exceeding reference plasma levels.
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Affiliation(s)
- Marco Pozzi
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
| | - Nicoletta Zanotta
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
| | - Roberta Epifanio
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
| | - Sara Baldelli
- Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco University Hospital, 20157 Milan, Italy
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco University Hospital, 20157 Milan, Italy
| | - Emilio Clementi
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy; Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, Luigi Sacco University Hospital, University of Milan, 20157 Milan, Italy.
| | - Claudio Zucca
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
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Yang C, Peng Y, Zhang L, Zhao L. Safety and Tolerability of Lacosamide in Patients With Epilepsy: A Systematic Review and Meta-Analysis. Front Pharmacol 2021; 12:694381. [PMID: 34616294 PMCID: PMC8488108 DOI: 10.3389/fphar.2021.694381] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/23/2021] [Indexed: 01/03/2023] Open
Abstract
Background: As a third-generation antiseizure medication (ASM), lacosamide (LCM) is recommended worldwide for patients with epilepsy. We aimed to provide more conclusive evidence for the safety and tolerability of LCM in patients with epilepsy. Methods: A systematic search was performed on MEDLINE, Embase, Cochrane Library, CBM, CNKI, IDB, VIP Database, and Wanfang Database from inception to 2021 March, and all studies assessing the safety of LCM were included. A meta-analysis was performed for safety data of LCM. Results: Eighty-three studies involving 12268 populations (11 randomized clinical trials (RCTs), 16 cohort studies, 53 case series, and 3 case reports) were included in our study. Meta-analysis of the total incidence of adverse events (AEs) of LCM was 38.7% [95% CI (35.1%, 45.8%); n=75 studies]. Incidence of withdrawal due to AEs was 10.8% [95% CI (9.1%, 12.6%); n=56 studies], and incidence of serious adverse events (SAEs) was 6.5% [95% CI (4.0%, 8.9%); n=13 studies]. Most AEs were in the nervous system and digestive system. The most common AEs were sedation (15.8%), dizziness (15.7%), fatigue (9.4%), and nausea/vomiting (9.3%). For children, the total incidence of AEs of LCM was 32.8% [95% CI (21.6%, 44.0%); n=16 studies], and the most common AEs were dizziness (8.6%), nausea/vomiting (8.6%), and somnolence (6.8%). Conclusion: Lacosamide is generally safe and well tolerated in patients with epilepsy. Common AEs were sedation, dizziness, and fatigue. It is necessary to pay more attention to the prevention and management of these AEs and conduct more large-scale and high-quality studies to update safety data.
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Affiliation(s)
- Chunsong Yang
- Department of Pharmacy, Evidence-Based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Yuxuan Peng
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Lingli Zhang
- Department of Pharmacy, Evidence-Based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Li Zhao
- Department of Health Policy and Management, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu, China
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Yamamoto Y, Terada K, Araki Y, Fukushima Y, Imai K, Kagawa Y, Takahashi Y. Therapeutic Monitoring of Lacosamide in Japanese Patients With Epilepsy: Clinical Response, Tolerability, and Optimal Therapeutic Range. Ther Drug Monit 2020; 42:754-759. [PMID: 32941398 DOI: 10.1097/ftd.0000000000000764] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lacosamide is a novel anticonvulsant that acts by enhancing sodium channel slow inactivation. The aims of this study were to evaluate the influence of concomitant antiepileptic drugs (AEDs) on serum lacosamide concentration and explore the relationship between lacosamide serum concentration and both clinical response and adverse effects. METHODS The authors analyzed 649 serum samples from 426 Japanese patients with epilepsy. The concentration-to-dose (CD) ratio of lacosamide was compared among patients on various AED regimens. Clinical information about seizure frequency and adverse events was obtained from clinical records. RESULTS In patients who did not receive enzyme-inducing AEDs, the CD ratio (mean ± SD) of lacosamide was 1.84 ± 0.68. By contrast, the CD ratio in patients who received phenytoin, carbamazepine, and phenobarbital was 1.42 ± 0.66 (22.8% lower), 1.46 ± 0.40 (20.7% lower), and 1.36 ± 0.38 (26.1% lower), respectively. Seventy-four patients (17.3%) achieved >50% seizure reduction. The median lacosamide concentration in patients who received and did not receive a sodium channel blocker was 6.6 mcg/mL (26.4 μmol/L) and 8.4 mcg/mL (33.6 μmol/L), respectively. Adverse events, including dizziness, somnolence, diplopia, and anorexia, were reported by 70 patients (16.4%). The incidence rate in patients treated with sodium channel blockers was significantly higher than that in patients not treated with these drugs (21.1% vs. 10.3%; P < 0.005), and the median lacosamide concentration in these patient groups was 5.1 (20.4 μmol/L) and 7.5 mcg/mL (30 μmol/L), respectively. CONCLUSIONS Therapeutic drug monitoring of lacosamide is clinically useful because it allows physicians to estimate the extent of drug interactions and adjust the dose in individual AED regimens.
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Affiliation(s)
- Yoshiaki Yamamoto
- Department of Clinical Research, NHO, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama
- Department of Clinical Pharmaceutics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Yada; and
| | - Kiyohito Terada
- Department of Clinical Research, NHO, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama
| | - Yasukiyo Araki
- Department of Clinical Research, NHO, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama
| | - Yutaro Fukushima
- Department of Clinical Research, NHO, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama
| | - Katsumi Imai
- Department of Clinical Research, NHO, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama
| | - Yoshiyuki Kagawa
- Department of Clinical Pharmaceutics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Yada; and
- Laboratory of Clinical Pharmacokinetics and Drug Safety, Shizuoka General Hospital, Kita Ando, Shizuoka, Japan
| | - Yukitoshi Takahashi
- Department of Clinical Research, NHO, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama
- Department of Clinical Pharmaceutics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Yada; and
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Liu A, Gu Q, Wang M. Effects of levetiracetam and lacosamide on therapeutic efficacy and neural function in patients with epilepsy. Exp Ther Med 2020; 20:3687-3694. [PMID: 32905038 PMCID: PMC7465612 DOI: 10.3892/etm.2020.9126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/16/2020] [Indexed: 12/27/2022] Open
Abstract
The present study aimed to investigate the effects of levetiracetam tablets and lacosamide (LCM) on therapeutic efficacy and neural function in patients with epilepsy. We assigned 252 patients with refractory partial seizures admitted to our hospital to receive either levetiracetam tablets [120 patients, the control group (CG)] or levetiracetam tablets combined with LCM [132 patients, the joint group (JG)]. The bone mineral density and neural function between the two groups at 6 months before and after treatment were compared. The total response rate was higher in the JG than in the CG (P<0.05). There was no significant difference in the comparison of the multiple indexes between the two groups before treatment (P>0.05). The frequency of seizures was reduced after treatment in the two groups, however, it was lower in the JG compared with the CG (P<0.05). The levels of neurological indicators were significantly reduced after treatment in the two groups (P<0.05), however, the reduction was more marked in the JG than in the CG. The bone mineral density (BMD) of the femoral neck decreased after treatment in the two groups (P<0.05), but there was no difference between the two groups after treatment (P>0.05). The calcium content decreased after treatment in the two groups (P<0.05), but there was no difference between the two groups after treatment (P>0.05). The comparison of other bone metabolism markers between the two groups exhibited no significant differences. The combination therapy greatly increased the quality of life score and the 1-year drug retention rate. To sum up, levetiracetam tablets combined with LCM significantly enhanced the therapeutic effect and improved the neural function in patients with refractory partial seizures, however this therapy may cause a slight adverse effect on BMD and bone metabolism in the short term.
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Affiliation(s)
- Airong Liu
- Hong Kong Middle Road Clinic, Integrated Chinese and Western Medicine Hospital of Qingdao (The 5th People's Hospital of Qingdao), Qingdao, Shandong 266073, P.R. China
| | - Qiuling Gu
- Hong Kong Middle Road Clinic, Integrated Chinese and Western Medicine Hospital of Qingdao (The 5th People's Hospital of Qingdao), Qingdao, Shandong 266073, P.R. China
| | - Mingjing Wang
- Hong Kong Middle Road Clinic, Integrated Chinese and Western Medicine Hospital of Qingdao (The 5th People's Hospital of Qingdao), Qingdao, Shandong 266073, P.R. China
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Svendsen T, Brodtkorb E, Baftiu A, Lossius MI, Nakken KO, Johannessen SI, Johannessen Landmark C. Clinical experience combined with therapeutic drug monitoring of lacosamide. Acta Neurol Scand 2020; 141:279-286. [PMID: 31853958 DOI: 10.1111/ane.13206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/03/2019] [Accepted: 12/14/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Lacosamide (LCM) is an antiepileptic drug (AED) with insufficient clinical experience in patients with intellectual disability (ID). They often have more severe epilepsy with comorbidities. The objective was to evaluate the efficacy and tolerability of lacosamide (LCM) in patients with refractory epilepsy with and without ID in a real-life setting, taking drug monitoring (TDM) data into account therapeutic. METHODS Retrospectively, we identified 344 patients using LCM from the TDM service covering the majority of the country, at the National Center for Epilepsy in Norway (2013-2018). Clinical and TDM data were available for 132 patients. RESULTS Forty-four of the 132 patients (33%) had ID. The retention rate was significantly higher in the ID vs the non-ID group after 1 year (84% vs 68%, P < .05). By combining clinical and TDM data, we demonstrated that 37/38 responding patients had serum concentrations above the lower limit of the reference range (>10 µmol/L), and 16/17 with lower concentrations were non-responders. Mean serum concentration/dose ratios were similar in both groups, 0.06 and 0.07 µmol/L/mg. There were no significant differences regarding efficacy and tolerability. The risk of LCM withdrawal was significantly higher when LCM was added to sodium channel blockers, even if the latter was discontinued. SIGNIFICANCE Lacosamide was generally well tolerated in patients with drug-resistant epilepsy, where one third had ID, and in these patients the retention rate was higher. The combination of clinical and TDM data could possibly facilitate LCM therapy in these vulnerable patients.
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Affiliation(s)
- Torleiv Svendsen
- The National Center for Epilepsy, SandvikaOslo University Hospital Oslo Norway
- Department of Neurology Innlandet Hospital Trust Lillehammer Norway
| | - Eylert Brodtkorb
- Department of Neurology and Clinical Neurophysiology St. Olav's University Hospital Trondheim Norway
- Department of Neuroscience Norwegian University of Science and Technology Trondheim Norway
| | - Arton Baftiu
- The National Center for Epilepsy, SandvikaOslo University Hospital Oslo Norway
- The Norwegian Medicines Agency Oslo Norway
| | - Morten I. Lossius
- The National Center for Epilepsy, SandvikaOslo University Hospital Oslo Norway
- Oslo University Oslo Norway
| | - Karl O. Nakken
- The National Center for Epilepsy, SandvikaOslo University Hospital Oslo Norway
| | - Svein I. Johannessen
- The National Center for Epilepsy, SandvikaOslo University Hospital Oslo Norway
- Program for Pharmacy Department of Life Sciences and Health Faculty of Health Sciences Oslo Metropolitan University Oslo Norway
| | - Cecilie Johannessen Landmark
- The National Center for Epilepsy, SandvikaOslo University Hospital Oslo Norway
- Program for Pharmacy Department of Life Sciences and Health Faculty of Health Sciences Oslo Metropolitan University Oslo Norway
- Section for Clinical Pharmacology Department of Pharmacology Oslo University Hospital Oslo Norway
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Allard J, Henley W, Mclean B, Sellers A, Hudson S, Rajakulendran S, Pace A, Pashley S, Maguire M, Mohan M, Ellawela S, Tittensor P, Ram S, Bagary M, Shankar R. Lacosamide in the general population and in people with intellectual disability: Similar responses? Seizure 2020; 76:161-166. [PMID: 32106016 PMCID: PMC7113834 DOI: 10.1016/j.seizure.2020.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/18/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Epilepsy prevalence is significantly higher in people with Intellectual Disability (ID) compared to people with epilepsy (PWE) from the general population. Increased psychological and behavioural problems, healthcare costs, morbidity, mortality and treatment resistance to antiepileptic drugs (AEDs) is associated with epilepsy in ID populations. Prescribing AEDs for PWE and ID is challenging and influenced heavily by studies conducted with the general population. Our study compares Lacosamide (LCM) response for the ID population to those from the general population; using data from an UK based epilepsy database register (EP ID/PDD AED Register). METHODS Pooled retrospective case notes data for PWE prescribed LCM at 11 UK NHS Trusts were analysed. Participants were classified as per WHO guidance into groups of moderate-profound ID, mild ID and General population. Demographics, concomitant AEDs, starting and maximum dosage, exposure length, adverse effects, dropout rates, seizure frequency were collected. Group differences were reported as odds ratios estimated from univariable logistic regression models. RESULTS Of 232 consented participants, 156 were from the general population and 76 had ID (24 mild, 52 moderate-profound). Twelve month withdrawal rates and reasons, efficacy, side-effects, start and maximum doses were similar between the groups. Dose titration between baseline and three months was significantly slower in the ID group (p = 0.02). CONCLUSION There were no differences for LCM outcomes between general and ID groups. Slower LCM titration in ID populations in the first 3 months was associated with higher retention and lower behavioural side effects as compared to similar European studies.
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Affiliation(s)
- Jon Allard
- Cornwall Partnership NHS Foundation Trust, United Kingdom
| | | | - Brendan Mclean
- Royal Cornwall Hospital NHS Foundation Trust, United Kingdom
| | - Adrian Sellers
- Cornwall Partnership NHS Foundation Trust, United Kingdom
| | - Sharon Hudson
- Cornwall Partnership NHS Foundation Trust, United Kingdom
| | - Sanjeev Rajakulendran
- National Centre for Neurology and Neurosurgery, University College Hospitals NHS Foundation Trust, United Kingdom
| | - Adrian Pace
- Salford Royal NHS Foundation Trust, United Kingdom
| | - Sarah Pashley
- Nottinghamshire Healthcare NHS Foundation Trust, United Kingdom
| | | | | | - Shan Ellawela
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom
| | | | - Sunil Ram
- Somerset Partnership NHS Foundation Trust, United Kingdom
| | - Manny Bagary
- Birmingham and Solihull Mental Health NHS Foundation Trust, United Kingdom
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, United Kingdom; University of Exeter Medical School, United Kingdom.
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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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Lacosamide in patients with intellectual disability and refractory epilepsy. Acta Neurol Belg 2019; 119:423-430. [PMID: 30840220 DOI: 10.1007/s13760-019-01098-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Abstract
The objective of this study was to evaluate the tolerability and efficacy of lacosamide (LCM) in residential patients at our epilepsy centre. We assessed retrospectively 80 patients (mean age 36.2 years, range 18-63 years; 29 female) with intellectual disability (ID) and drug-resistant epilepsy using an industry-independent, non-interventional study design based on standardised seizure records. Evaluation, including calculation of retention rate, was carried out for the intervals 3-6, 9-12 and 21-24 months after LCM initiation. The Clinical Global Impression scale (CGI) was used to allow assessment of qualitative changes in seizure severity and clinical status. CGI improved for 61% of the patients. The responder rate was 48%; ten patients (13%) became seizure free. The response was not related to the degree of ID. The retention rates after 12 and 24 months were 71% and 65%, and were significantly lower in patients taking other sodium-channel blockers (SCBs; 76% vs. 55%). The occurrence of adverse events (AEs) was related to the administration of concomitant SCBs (48% with SCBs vs. 26% without). Sedation (15%), ataxia (13%), vertigo (11%), and nausea (9%) were the commonest AEs. While 60% of our patients had concomitant psychiatric diagnosis, we found no relevant effect of this on challenging behaviour. Adjunctive LCM may provide an antiepileptic treatment option for patients with ID with or without additional psychiatric diagnosis. The occurrence of AEs and the LCM retention rate were affected by concomitant SCB use but not by psychiatric comorbidity.
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Doğan EA, Doğan U, Genç E, Erdoğan Ç, Genç BO. Adjunctive lacosamide treatment for adult focal-onset epilepsy: focus on comorbid intellectual/developmental disorders and differing responses. Ther Clin Risk Manag 2018; 14:1369-1377. [PMID: 30122936 PMCID: PMC6080872 DOI: 10.2147/tcrm.s171793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background Data regarding lacosamide treatment as an adjunctive therapy in patients representative of a focal-onset epilepsy population including those with and without intellectual/developmental disorders (IDDs) are limited. Purpose To evaluate the retention rates of lacosamide in focal-onset epilepsy patients with and without IDD. Patients and methods We retrospectively reviewed all consecutive electronic and paper medical records of patients diagnosed with focal-onset epilepsy who were treated with lacosamide in two tertiary epilepsy centers. Results One hundred and thirty-six patients who met the inclusion criteria were studied. Number of patients with IDD was 46 (33.8%). Median lacosamide dose was 300 mg/day. A total of 39 patients (28.7%) experienced side effects, and 22 of them (16.2%) discontinued lacosamide. The 1-, 2-, and 3-year retention rates of lacosamide in patients with IDD were 68%, 62%, and 53%, respectively. Kaplan–Meier survival analysis showed that the retention rates were significantly lower in patients with IDD when compared to patients without IDD (P=0.04). Cox regression analysis showed that concomitant use of sodium channel blocker antiepileptic drugs (AEDs) was the only independent predictor of retention rate of lacosamide treatment (P=0.03). In the subgroup of patients with IDD, the analysis was performed again and the number of background AEDs was the only predictor for the retention rate of lacosamide (P=0.04). Conclusion When compared to patients without IDD, retention rates of lacosamide adjunctive therapy were lower in patients with IDD. However, these rates were higher than the rates suggested with previously registered AEDs including lamotrigine, levetiracetam, and topiramate. Therefore, irrespective of having comorbid IDD, we might suggest that lacosamide is a well-retained drug with a high efficacy profile in patients with focal-onset epilepsy.
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Affiliation(s)
- Ebru Apaydın Doğan
- Department of Neurology, School of Medicine, Akdeniz University, Antalya, Turkey,
| | - Umuttan Doğan
- Department of Cardiology, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Emine Genç
- Department of Neurology, School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Çağla Erdoğan
- Department of Neurology, School of Medicine, Akdeniz University, Antalya, Turkey,
| | - Bülent Oğuz Genç
- Department of Neurology, School of Medicine, Necmettin Erbakan University, Konya, Turkey
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Rosati A, Ilvento L, Rizzi R, Doccini V, Leo MC, Pugi A, De Masi S, Guerrini R. Long-term efficacy of add-on lacosamide treatment in children and adolescents with refractory epilepsies: A single-center observational study. Epilepsia 2018; 59:1004-1010. [PMID: 29663335 DOI: 10.1111/epi.14071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To assess long-term efficacy and tolerability of lacosamide (LCM) as adjunctive treatment through a retrospective study in children and adolescents with refractory epilepsies. METHODS All patients consecutively treated with LCM as add-on for refractory focal and generalized epilepsy and followed at the Neuroscience Center of Excellence of the Meyer Children's Hospital of Florence between January 2011 and September 2015 were included in the study. Responder rate, relapse-free survival, and retention rate were calculated. Tolerability was assessed by reporting adverse events. RESULTS A total of 88 individuals (41 female) aged 4 months to 18 years (median 10.5 years; mean ± SD 10.6 ± 4.8 years) received add-on LCM treatment for refractory epilepsy. Thirty-four patients (38.6%) were responders with a median time to relapse of 48 months. Nine (26.4%) of the 34 responders were seizure-free. For all 88 patients, the probability of remaining on LCM without additional therapy was 74.4% at 6 months, 47.7% at 12 months, 27.9% at 24 months, 18.0% at 48 months, and 8.2% at 72 months of follow-up. No statistically significant differences in relapse and retention time were observed with regard to epilepsy and seizure types, duration and course of epilepsy, number and type of antiepileptic drugs (AEDs; sodium channel blockers vs others) used in add-on. The most frequent adverse events were dermatological (4/11) and behavioral (3/11). SIGNIFICANCE This study documents a real-world progressive and significant loss of LCM efficacy over time in a pediatric population. Further prospective studies on larger populations are required to confirm the remarkable loss of LCM efficacy over time.
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Affiliation(s)
- Anna Rosati
- Neuroscience Center of Excellence, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Lucrezia Ilvento
- Neuroscience Center of Excellence, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Riccardo Rizzi
- Neuroscience Center of Excellence, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Viola Doccini
- Neuroscience Center of Excellence, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Maria Carmela Leo
- Pediatric Ethics Committee, Meyer Children's Hospital, Florence, Italy
| | - Alessandra Pugi
- Clinical Trial Office, Meyer Children's Hospital, Florence, Italy
| | | | - Renzo Guerrini
- Neuroscience Center of Excellence, Meyer Children's Hospital, University of Florence, Florence, Italy
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Brenner J, Majoie HJM, van Beek S, Carpay JA. The retention of lacosamide in patients with epilepsy and intellectual disability in three specialised institutions. Seizure 2017; 52:123-130. [PMID: 29031193 DOI: 10.1016/j.seizure.2017.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/01/2017] [Accepted: 09/27/2017] [Indexed: 12/19/2022] Open
Abstract
PURPOSE We describe the effectiveness of lacosamide as adjunctive therapy in patients with epilepsy and an intellectual disability. This information is relevant, as few data exist pertaining to this population with a high prevalence of (intractable) epilepsy. METHODS We performed a retrospective study in three specialised institutions. Inclusion criteria were (1) focal onset or symptomatic generalized (2) therapy-resistant epilepsy, (3) intellectual disability and (4) residence in a care-facility for people with intellectual disabilities (PWID). The primary outcome variables were the retention rates of lacosamide, estimated through Kaplan-Meier survival analysis. Secondary outcomes were reported seizure control, side effects and clinical factors influencing discontinuation. RESULTS One hundred and thirty-two patients were included. The median retention time of lacosamide in our cohort was four years. The estimated one-, two- and three-year retention rates of lacosamide were 64%, 57% and 56% respectively. Severity of intellectual disability and seizure type did not influence whether lacosamide was continued. In 48.5% of patients, a reduction of seizure activity was reported. Side effects were at least part of the reason for discontinuing treatment in 26.5% of all patients. Common side effects were tiredness/somnolence (in 30.3%), aggression/agitation (24.2%), and instable gait (15.2%). Five deaths during follow-up were considered unlikely to be related to the use of lacosamide. One patient died unexpectedly within two months of treatment onset, probably this was a case of SUDEP. CONCLUSION These retention rates of lacosamide in PWID are similar to rates of previously registered anti-epileptic drugs in PWID. Behavioural side effects were noted in a high proportion compared to the general literature on lacosamide. Other side effects were in line with this literature. Lacosamide seems effective and safe for PWID and refractory epilepsy.
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Affiliation(s)
- J Brenner
- University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | - H J M Majoie
- Department of Neurology, Academic Center of Epileptology Kempenhaeghe, Sterkselseweg 65, 5591 VE Heeze, The Netherlands; School of Mental Health & Neuroscience and School of Health Professions Education, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
| | - S van Beek
- SEIN Epilepsy Centre, Achterweg 5, 2103 SW Heemstede, The Netherlands.
| | - J A Carpay
- Department of Neurology, Tergooi Hospital, Rijksstraatweg 1, 1261 AN Blaricum, The Netherlands.
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