Early versus late antiepileptic drug withdrawal for people with epilepsy in remission

Strozzi, Isabella; Nolan, Sarah J; Sperling, Michael R.; Wingerchuk, Dean M.; Sirven, Joseph I

doi:10.1002/14651858.cd001902.pub2

Cited by 73 publications

(59 citation statements)

References 39 publications

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“…Lifelong epilepsy treatment was assumed as there is limited evidence that supports AED withdrawal in seizure‐free adults, owing to the higher‐than‐average risk of seizure relapse associated with adult‐onset epilepsy and partial seizures …”

Section: Methodsmentioning

confidence: 99%

Is universal HLA-B15:02* screening a cost-effective option in an ethnically diverse population? A case study of Malaysia

et al. 2017

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Background Strong association was documented between human leukocyte antigen (HLA)-B*15:02 and carbamazepine-induced severe cutaneous adverse reactions (SCARs) in Asians. Beyond Asia, the HLA testing is potentially valuable in many countries with increasingly diverse communities of Asian ancestry, to facilitate an early recognition of patient susceptibility to SCARs. Objective To determine the cost-effectiveness of universal HLA-B*15:02 screening in preventing carbamazepine-induced Stevens-Johnson syndrome/ toxic epidermal necrolysis in an ethnically-diverse Malaysian population. Methods A hybrid model of a decision tree and Markov model was developed to evaluate three strategies for treating newly-diagnosed epilepsy among adults - (i) carbamazepine initiation without HLA-B*15:02 screening (current practice); (ii) universal HLA-B*15:02 screening prior to carbamazepine initiation; and (iii) alternative treatment [sodium valproate (VPA)] prescribing without HLA-B*15:02 screening. From a societal perspective, base-case analysis and sensitivity analyses were performed over lifetime time horizon. Incremental cost-effectiveness ratios were calculated. Results In the base-case analysis, both universal HLA-B*15:02 screening and VPA prescribing were dominated by current practice. Compared to current practice, universal HLA-B*15:02 screening resulted in 0.0255 quality-adjusted life years (QALYs) loss at an additional cost of USD707, while VPA prescribing resulted in 0.2622 QALYs loss at an additional cost of USD4,127, due to estimated differences in antiepileptic treatment efficacy. Conclusions This study suggests that universal HLA-B*15:02 screening is unlikely to be a cost-effective intervention in Malaysia compared to current practice. However, with the emergence of an ethnically-diverse population in many other countries, this may render HLA-B*15:02 screening a potentially viable intervention when an increasing proportion of the population is at risk and an equally effective yet safer antiepileptic drug is available.

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Section: Methodsmentioning

confidence: 99%

Is universal HLA-B15:02* screening a cost-effective option in an ethnically diverse population? A case study of Malaysia

et al. 2017

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“…Risikoen for tilbakefall ved tidlig seponering var ytterligere økt dersom barna hadde fokale anfall, psykisk utviklingshemning og/eller patologisk EEG-resultat (23).…”

Section: Få Gode Studierunclassified

Seponering av antiepileptika ved anfallsfrihet – når og hvordan?

Lossius¹,

Alfstad²,

Aaberg³

et al. 2017

Tidsskriftet

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“…Среди испытуемых лишь у 2 пациентов отмечена попытка отмены АЭП после 5-летней ремис-сии, и в обоих случаях терапию пришлось восстановить по причине возобновления приступов. Для принятия решения о целесообразности отмены АЭП или коррек-ции терапии пациентам с длительной ремиссией необ-ходимо учитывать ряд факторов, которые повышают риск рецидива в будущем: парциальный характер при-ступов, наличие провокаторов приступов, эпилепти-формные изменения на ЭЭГ, структурные изменения головного мозга на МРТ, очаговые неврологические симптомы [31]. Возобновление приступов может быть обусловлено развитием толерантности к АЭП.…”

Section: Ch I Ld Neurology R U S S I a N J O U R N A L O Funclassified

Focal Epilepsies: Pathomorphosis Types

Амирханян¹,

Котов²,

Елисеев³

et al. 2017

Rus. ž. det. nevrol.

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Early versus late antiepileptic drug withdrawal for people with epilepsy in remission

Abstract: Early versus late antiepileptic drug withdrawal for people with epilepsy in remission.

Cited by 73 publications

References 39 publications

Is universal HLA-B15:02* screening a cost-effective option in an ethnically diverse population? A case study of Malaysia

Is universal HLA-B15:02* screening a cost-effective option in an ethnically diverse population? A case study of Malaysia

Seponering av antiepileptika ved anfallsfrihet – når og hvordan?

Focal Epilepsies: Pathomorphosis Types

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Early versus late antiepileptic drug withdrawal for people with epilepsy in remission

Abstract: Early versus late antiepileptic drug withdrawal for people with epilepsy in remission.

Cited by 73 publications

References 39 publications

Is universal HLA-B*15:02 screening a cost-effective option in an ethnically diverse population? A case study of Malaysia

Is universal HLA-B*15:02 screening a cost-effective option in an ethnically diverse population? A case study of Malaysia

Seponering av antiepileptika ved anfallsfrihet – når og hvordan?

Focal Epilepsies: Pathomorphosis Types

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Product

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Is universal HLA-B15:02* screening a cost-effective option in an ethnically diverse population? A case study of Malaysia

Is universal HLA-B15:02* screening a cost-effective option in an ethnically diverse population? A case study of Malaysia