Transition from oxcarbazepine to eslicarbazepine acetate: A single center study

Abstract

ObjectivesThere is limited clinical evidence for comparison between oxcarbazepine (OXC) and eslicarbazepine acetate (ESL) in terms of tolerability, or how to execute the change from OXC to ESL. We report the process of transitioning patients with focal epilepsy from previous OXC treatment to ESL due to tolerability problems. The rationale for change from OXC is reported, and the outcome with respective to this rationale is analyzed in terms of tolerability and efficacy.Materials and MethodsThe subjects were transitioned overnight from OXC to ESL in a hospital inpatient setting. An evaluation of the effects of the transition was made after 1 and 3 months. All adverse events (AEs) were recorded following the transition period. Subjects were classified by outcome in terms of AEs.ResultsTwenty‐three subjects were transitioned from OXC to ESL. Fifteen patients OXC‐related AEs reduced significantly after transition. Particularly, most of (93%) the AEs presented in the morning resolved after transition to ESL. No patient had an increase in seizure frequency following the transition. The incidence of ESL‐related AEs was 39% at 1 month and 13% at 3 month follow‐up; however, all patients continued ESL throughout the study period.ConclusionsThis study demonstrates that patients suffering from OXC‐related AEs improve in terms of tolerability after a switch to ESL with maintaining seizure control. This improvement is more pronounced if the OXC‐related AEs are most evident following morning dosing of OXC. Transition can be safely executed in an outpatient setting.

Dibenzazepine Agents in Epilepsy: How Does Eslicarbazepine Acetate Differ?

“…The most intolerable OXC-related AEs were somnolence, dizziness, and diplopia [ 34 ], consistent with the aforementioned pattern of OXC metabolism [ 19 ]. OXC-related AEs had resolved in 14/23 (60.9%) and 15/23 (65.2%) patients 1 and 3 months after transition, respectively [ 34 ]. Two-thirds (66.5%) of OXC-related AEs occurred in the morning and 93.4% of these resolved after transitioning from OXC to ESL [ 34 ].…”

“…Several real-world clinical practice studies have investigated the impact on tolerability of transitioning patients who were experiencing OXC- or CBZ-related AEs to ESL [ 31 – 37 ]. In a single-center, retrospective chart review of 23 patients with focal epilepsy who were transitioned overnight from OXC to ESL because of tolerability problems, an evaluation of the effects of the transition was made after 1 and 3 months of ESL treatment [ 34 ]. The most intolerable OXC-related AEs were somnolence, dizziness, and diplopia [ 34 ], consistent with the aforementioned pattern of OXC metabolism [ 19 ].…”

“…In a single-center, retrospective chart review of 23 patients with focal epilepsy who were transitioned overnight from OXC to ESL because of tolerability problems, an evaluation of the effects of the transition was made after 1 and 3 months of ESL treatment [ 34 ]. The most intolerable OXC-related AEs were somnolence, dizziness, and diplopia [ 34 ], consistent with the aforementioned pattern of OXC metabolism [ 19 ]. OXC-related AEs had resolved in 14/23 (60.9%) and 15/23 (65.2%) patients 1 and 3 months after transition, respectively [ 34 ].…”

Eslicarbazepine acetate as monotherapy in clinical practice: Outcomes from Euro-Esli

“…The Euro-Esli study was an exploratory, retrospective, pooled analysis of data from European clinical practice studies, [9][10][11][12][13][14][15][16][17][18][19][20][21] conducted to audit the effectiveness, safety, and tolerability of ESL as an adjunctive treatment for focal-onset seizures in clinical practice, details of which have been published previously. 8 In brief, effectiveness was assessed after 3, 6, and 12 months of ESL treatment and at final follow-up, and safety and tolerability were assessed for the duration of ESL treatment.…”

Eslicarbazepine acetate in the treatment of adults with partial-onset epilepsy: an evidence-based review of efficacy, safety and place in therapy

“…The overnight OXC-ESL transition resulted in improvements in side effects, quality of life and alertness, while maintaining seizure control. 45 , 46 In addition, compared with the first- and second-generation dibenzazepine as well as the traditional inducer AEDs, ESL may be preferred in patients at higher vascular risk 47 , 48 by exhibiting a safer profile according to lipid metabolism and atherosclerosis development. 49 – 51 …”