Long-term retention rate of topiramate as initial monotherapy in Chinese patients with newly diagnosed epilepsy: A prospective, observational study

Hu, Yun; Lü, Yang; Yu, Weihua; Shen, Dinglie; Xiao, Zheng; Xi, Zhiqin; Wang, Xuefeng

doi:10.1016/j.eplepsyres.2010.06.004

Cited by 10 publications

(5 citation statements)

References 27 publications

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“…This likely explains the apparent higher rate of discontinuation in the add‐on group, and is supported by the finding of a much earlier withdrawal of new ASM introduced by addition as compared to substitution. We also found that female patients had a higher rate of ASM discontinuation than male patients, concordant with previous prospective observational studies 21‐23 . Higher Adverse Event Profile questionnaire scores were reported in female patients by Canevini et al, 9 and the SANAD trial 23 found that female patients had a significantly higher rate of unacceptable adverse events and associated treatment failure.…”

Section: Discussionsupporting

confidence: 91%

Starting a new anti‐seizure medication in drug‐resistant epilepsy: Add‐on or substitute?

Janmohamed

Lawn²,

Spilsbury

et al. 2020

Epilepsia

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ObjectivesRandomized studies in drug‐resistant epilepsy (DRE) typically involve addition of a new anti‐seizure medication (ASM). However, in clinical practice, if the patient is already taking multiple ASMs, then substitution of one of the current ASMs commonly occurs, despite little evidence supporting this approach.MethodsLongitudinal prospective study of seizure outcome after commencing a previously untried ASM in patients with DRE. Multivariable time‐to‐event and logistic regression models were used to evaluate outcomes by whether the new ASM was introduced by addition or substitution.ResultsA total of 816 ASM changes in 436 adult patients with DRE between 2010 and 2018 were analyzed. The new ASM was added on 407 (50.1%) occasions and substituted on 409 (49.9%). Mean patient follow‐up was 3.2 years. Substitution was more likely if the new ASM was enzyme‐inducing or in patients with a greater number of concurrent ASMs. ASM add‐on was more likely if a γ‐aminobutyric acid (GABA) agonist was introduced or if the patient had previously trialed a higher number of ASMs. The rate of discontinuation due to lack of tolerability was similar between the add‐on and substitution groups. No difference between the add‐on and substitution ASM introduction strategies was observed for the primary outcome of ≥50% seizure reduction at 12 months.SignificanceAdding or substituting a new ASM in DRE has the same influence on seizure outcomes. The findings confirm that ASM alterations in DRE can be individualized according to concurrent ASM therapy and patient characteristics.

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Section: Discussionsupporting

confidence: 91%

Starting a new anti‐seizure medication in drug‐resistant epilepsy: Add‐on or substitute?

Janmohamed

Lawn²,

Spilsbury

et al. 2020

Epilepsia

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“…On the whole, LTG showed the best safety excluding rash, OXC had better tolerability than CBZ. In long-term phase, TPM had the highest AE incidence, AEs including kidney calculus and cognitive impairments should be paid attention to while using TPM [ 9 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Comparative Long-Term Effectiveness of a Monotherapy with Five Antiepileptic Drugs for Focal Epilepsy in Adult Patients: A Prospective Cohort Study

et al. 2015

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ObjectiveTo evaluate and compare long-term effectiveness of five antiepileptic drugs (AEDs) for monotherapy of adult patients with focal epilepsy in routine clinical practice.MethodsAdult patients with focal epilepsy, who were prescribed with carbamazepine (CBZ), valproate (VPA), lamotrigine (LTG), topiramate (TPM), or oxcarbazepine (OXC) as monotherapy, during the period from January 2004 to June 2012 registered in Wenzhou Epilepsy Follow Up Registry Database (WEFURD), were included in the study. Prospective long-term follow-up was conducted until June 2013. The endpoints were time to treatment failure, time to seizure remission, and time to first seizure.ResultsThis study included 654 patients: CBZ (n=125), VPA (n=151), LTG (n=135), TPM (n=76), and OXC (n=167). The retention rates of CBZ, VPA, LTG, TPM, and OXC at the third year were 36.1%, 32.4%, 57.6%, 37.9%, and 41.8%, respectively. For time to treatment failure, LTG was significantly better than CBZ and VPA (LTG vs. CBZ, hazard ratio, [HR] 0.80 [95% confidence interval: 0.67-0.96], LTG vs. VPA, 0.53 [0.37-0.74]); TPM was worse than LTG (TPM vs. LTG, 1.77 [1.15-2.74]), and OXC was better than VPA (0.86 [0.78-0.96]). After initial target doses, the seizure remission rates of CBZ, VPA, LTG, TPM, and OXC were 63.0%, 77.0%, 83.6%, 67.9%, and 75.3%, respectively. LTG was significantly better than CBZ (1.44 [1.15-1.82]) and OXC (LTG vs. OXC, 0.76 [0.63-0.93]); OXC was less effective than LTG in preventing the first seizure (1.20 [1.02-1.40]).ConclusionLTG was the best, OXC was better than VPA only, while VPA was the worst. The others were equivalent for comparisons between five AEDs regarding the long-term treatment outcomes of monotherapy for adult patients with focal epilepsy in a clinical practice. For selecting AEDs for these patients among the first-line drugs, LTG is an appropriate first choice; others are reservation in the first-line but VPA is not.

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“…This long‐term retention rate compares favorably with newer AEDs used in similar settings. For instance, a recent study of topiramate as initial monotherapy for newly diagnosed epilepsy in southwest China estimated a probability of retention of 0.47 at 6 years (Hu et al., 2010). Retention of an AED is often regarded as a reflection of its effectiveness, which is a composite measure of efficacy and tolerability (Glauser et al., 2006).…”

Section: Discussionmentioning

confidence: 99%

Long‐term outcome of phenobarbital treatment for epilepsy in rural China: A prospective cohort study

Kwan

Wang

et al. 2012

Epilepsia

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SUMMARYPurpose: To evaluate the long-term outcome of phenobarbital treatment for convulsive epilepsy in rural China, and to explore factors associated with overall seizure outcomes. Methods: We carried out follow-up assessments of people who took part in an epilepsy community management program conducted in rural counties of six provinces in China. People with convulsive epilepsy who were previously untreated (or on irregular treatment) were commenced on regular treatment with phenobarbital. Information was collected using a standardized questionnaire by face-to-face interviews of the individuals (and their families where necessary). Information collected included treatment status, medication change, seizure frequency, and mortality. Key Findings: Among the 2,455 people who participated in the original program, outcomes were successfully ascertained during the follow-up assessment in 1986. Among them, 206 had died. Information on treatment response was obtained in 1,780 (56% male; mean age 33.9 years, range 3-84; mean duration of follow-up 6.4 years). Among them, 939 (53%) were still taking phenobarbital. The most common reasons for stopping phenobarbital were seizure freedom or substantial seizure reduction, socioeconomic reasons, and personal preference. Four hundred fifty-three individuals (25%) became seizure-free for at least 1 year while taking phenobarbital, 88% of whom did so at daily doses of 120 mg or below. Four hundred six (23%) reported adverse events, which led to withdrawal of phenobarbital in <1%. The most common adverse effects were malaise/somnolence (7.4%), dizziness (3%), and lethargy (2.6%). At the follow-up assessment, 688 (39%) individuals had been seizure free for at least the previous year. People with persistent seizures had significantly longer duration of epilepsy and higher number of seizures in the 12 months before treatment. People who were taking AED treatment irregularly at recruitment were less likely to become seizure-free. Significance: We observed long-term benefits of regular treatment with phenobarbital for convulsive epilepsy in rural China. One hundred years after the discovery of its antiepileptic effect, phenobarbital is still playing an important role in the management of epilepsy.

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Long-term retention rate of topiramate as initial monotherapy in Chinese patients with newly diagnosed epilepsy: A prospective, observational study

Cited by 10 publications

References 27 publications

Starting a new anti‐seizure medication in drug‐resistant epilepsy: Add‐on or substitute?

Starting a new anti‐seizure medication in drug‐resistant epilepsy: Add‐on or substitute?

Comparative Long-Term Effectiveness of a Monotherapy with Five Antiepileptic Drugs for Focal Epilepsy in Adult Patients: A Prospective Cohort Study

Long‐term outcome of phenobarbital treatment for epilepsy in rural China: A prospective cohort study

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