Comparative Effectiveness of 10 Antiepileptic Drugs in Older Adults With Epilepsy

Arif, Hiba; Buchsbaum, Richard; Pierro, Joanna; Whalen, Michael J.; Sims, Jessica; Resor, Stanley R.; Bazil, Carl W.; Hirsch, Lawrence J.

doi:10.1001/archneurol.2010.49

Cited by 107 publications

(76 citation statements)

References 19 publications

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“…A more recent study comparing LTG and LEV in a population aged ≥55 years, showed similar 12-month retention rates for the two drugs; however, the study was retrospective and uncontrolled. 33 One limitation inherent to the design of the current trial is the inclusion of the LTG arm for which the study was not powered. There were a number of reasons that led to this decision.…”

Section: Discussionmentioning

confidence: 99%

A randomized, double‐blind comparison of antiepileptic drug treatment in the elderly with new‐onset focal epilepsy

et al. 2015

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SUMMARYObjective: To compare the effectiveness of controlled-released carbamazepine (CR-CBZ) to levetiracetam (LEV) and to lamotrigine (LTG) in elderly patients with newly diagnosed focal epilepsy. Methods: Randomized, double-blind, parallel-group trial conducted between January 2007 and August 2011, in 47 ambulatory or hospital sites in Germany, Austria, or Switzerland. Eligible participants were aged ≥60, had new-onset epilepsy, had no acute illness as the cause of their seizures, and had no contraindication to the drugs in the trial. Patients were randomized 1:1:1 to CR-CBZ, LTG, or LEV. Doses were up-titrated for 6 weeks and could be maintained or adjusted depending on seizure relapse or tolerability over an additional period of 52 weeks. Primary outcome was the retention to treatment at week 58; secondary measures related to seizure and adverse event frequency. Results: Of 361 randomized patients, 359 were included (CR-CBZ n = 121, LTG n = 117, LEV n = 122) in the modified intent-to-treat population (mean age [range] 71.4 [60-95] years). At week 58, the retention rate for LEV was significantly higher than for CR-CBZ (61.5% vs. 45.8%, p = 0.02), and similar to LTG (55.6%). Seizure freedom rates at weeks 30 and 58 were not different across the groups. Twice as many patients receiving CR-CBZ discontinued due to adverse events or death compared to those in the LEV group (32.2% vs. 17.2%; odds ratio 2.28, 95% confidence interval [CI] 1.25-4.19, p = 0.007), whereas discontinuation was intermediate for LTG (26.3%). Median daily doses of completers (n = 195) were CR-CBZ 380.0 mg/day (333.0-384.0), LTG 95 mg/day (94.0-97.0), and LEV 950 mg/day (940.0-985.0). Significance: In the initial monotherapy of focal epilepsy in the elderly, 1-year retention to LEV was higher compared to CR-CBZ due to better tolerability. Retention of LTG was intermediate and close to LEV, but did not differ significantly from either comparators. NCT00438451, www.clinicaltrials.gov.

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Section: Discussionmentioning

confidence: 99%

A randomized, double‐blind comparison of antiepileptic drug treatment in the elderly with new‐onset focal epilepsy

et al. 2015

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“…The results showed that, without controlling for severity, lamotrigine had the highest 12-month retention rate (79%), which was significantly higher than carbamazepine (48%), gabapentin (59%), oxcarbazepine (24%), phenytoin (59%), and topiramate (56%). The retention rate for levetiracetam (73%) was the second highest and was significantly higher than those of carbamazepine and oxcarbazepine were (Arif et al, 2010). The EULEV cohort study evaluated the rates and factors associated with continuation of levetiracetam after 1 year.…”

Section: Retention Ratesmentioning

confidence: 99%

Treatment gaps of epilepsy and retention rates of sodium valproate in rural Guangxi, China

et al. 2014

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ABSTRACT. This study aimed to investigate the prevalence and treatment gaps of epilepsy, as well as the clinical effects, drug safety, and retention rates of sodium valproate (VPA) for treating epilepsy. Physicians received supervised training to use the survey form recommended by the Chinese Association Against Epilepsy while screening for suspected or confirmed epilepsy cases. These cases were ultimately enrolled in the study by neurologists. Enrolled patients were given a year of free VPA treatment so that its efficacy and adverse effects during the follow-up period could be evaluated. In total, 302 patients were enrolled in this study, which included 189 males and 113 females. Among these cases, 179 (59.27%) were confirmed to have generalized seizures, 162 (53.6%) had tonic-clonic seizures, 10 (3.3%) had absence seizures, and 123 (40.72%) had partial seizures. Only 63 patients had received regular treatments 1 week before enrollment, with a treatment gap of 79.1%. The retention rates during the 6th, 12th, 18th, and 24th months were 100, 93.56, 89.05, and 77.06%, respectively. During the 1-year follow-up period, 30 cases encountered mild adverse effects, but no severe adverse reactions were reported. A large treatment gap for epilepsy still existed in the rural areas of southern China, with few adverse effects and high

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“…Secondly, we assessed the effects of age and gender on retention rates of all eight AEDs due the fact that currently there is a lack of specific prescribing guidance for these subgroups of people with epilepsy [9].…”

Section: Introductionmentioning

confidence: 99%

Comparative effectiveness of eight antiepileptic drugs in adults with focal refractory epilepsy: the influence of age, gender, and the sequence in which drugs were introduced onto the market

et al. 2017

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Objectives: The first objective was to determine the long-term retention rate of eight antiepileptic drugs (AEDs) commonly used as adjunctive therapy in adults with focal refractory epilepsy. Secondly, we assessed the effects of age and gender on retention rates. Thirdly, we examined if the retention rate could be influenced by the sequence in which the AEDs had entered the market. Materials and methods: Patients with focal refractory epilepsy treated with any of the eight AEDs in Tampere UniversityHospital were identified retrospectively (N=507). Retention rates were evaluated with the Kaplan-Meier method. Followup started at the first date of treatment and each individual was followed a maximum of 36 months. Results:We calculated the following three-year retention rates; lacosamide, 77.1% (N=137); lamotrigine, 68.3% (N=177); levetiracetam 66.7% (N=319), clobazam, 65.6% (N=130); topiramate, 61.6% (N=178); zonisamide, 60.4% (N=103); pregabalin, 54.6% (N=127); gabapentin, 40.2% (N=66). Lacosamide, levetiracetam and clobazam were the most effective AEDs in the elderly. The retention rate for pregabalin was higher in males (65%) than females (51%) whereas females had higher retention rates for both topiramate (72% vs. 58%) and zonisamide (67% vs. 57%). The retention rate was influenced by the sequence in which these AEDs entered the market. Conclusion:We provide important information about practical aspects of these eight AEDs, revealing that there are differences in their effectiveness as adjunctive treatment for focal refractory epilepsy. Most importantly, the retention rate appears to be influenced by the sequence in which these AEDs were introduced onto the market.

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Comparative Effectiveness of 10 Antiepileptic Drugs in Older Adults With Epilepsy

Cited by 107 publications

References 19 publications

A randomized, double‐blind comparison of antiepileptic drug treatment in the elderly with new‐onset focal epilepsy

A randomized, double‐blind comparison of antiepileptic drug treatment in the elderly with new‐onset focal epilepsy

Treatment gaps of epilepsy and retention rates of sodium valproate in rural Guangxi, China

Comparative effectiveness of eight antiepileptic drugs in adults with focal refractory epilepsy: the influence of age, gender, and the sequence in which drugs were introduced onto the market

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