Adverse Effects of Levetiracetam in Newly Diagnosed and Treated Focal Epilepsy
Abstract number :
3.427
Submission category :
7. Anti-seizure Medications / 7D. Drug Side Effects
Year :
2022
Submission ID :
2232898
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:28 AM
Authors :
Piero Perucca, MD, PhD, FRACP – The University of Melbourne; Sarah Barnard, MIPH – Research Project Manager, Neurology, Monash University; Zhibin Chen, PhD – Monash University; Andres Kanner, MD – Univeristy of Miami; Manisha Holmes, MD – Westchester Medical Center Health; Pavel Klein, MD – The George Washington University; Bassel Abou-Khalil, MD – Vanderbilt University Medical Center; Barry Gidal, PharmD – University of Wisconsin; Jacqueline French, MD – New York University Grossman School of Medicine
This is a Late-Breaking abstract.
Rationale: Levetiracetam is currently the most prescribed anti-seizure medication (ASM) in newly diagnosed epilepsies.1 Half of patients will discontinue levetiracetam within two years due to intolerable adverse effects (AEs) or poor seizure control.2 Systematic screening can help identify ASM associated AEs that may preclude patients from reaching effective therapeutic doses or completing adequate trial periods. This study aimed to compare the AE profile of levetiracetam against other commonly prescribed ASMs in people with newly diagnosed focal epilepsy.
Methods: The Human Epilepsy Project (HEP) is a prospective, international, observational study aimed to identify clinical and biological markers of treatment response in people with newly diagnosed focal epilepsy. Participants were enrolled within 4 months of treatment initiation. Those on monotherapy who completed the Adverse Event Profile (AEP) and Mini International Neuropsychiatric Interview (MINI) at enrolment & among ASM groups with ≥20 users were included. Multivariable generalized linear & penalized logistic regression models assessed differences in total & itemised marginal AEP scores and dichotomized item responses (never or rarely vs. sometimes or always).
Results: A total of 225 participants on levetiracetam, lamotrigine, carbamazepine or oxcarbazepine monotherapy were included. There were no significant differences in total AEP scores across ASMs. Patients with a baseline diagnosis of depression (adjusted marginal score ratio [aMSR]=1.25, 95% CI: 1.11-1.41, p< 0.001) or anxiety (aMSR=1.15, 95 % CI: 1.05-1.27, p=0.004) had significantly increased total AEP scores, irrespective of ASM use. After adjusting for baseline depression and anxiety, levetiracetam users were 3.38 times more likely to experience feelings of aggression "sometimes" or "always" (95% CI: 1.07-10.7, p=0.038) and 55% less likely to experience unsteadiness (aOR = 0.45, 95% CI: 0.21-0.99, p=0.047) than lamotrigine users. Differences were not statistically significant after accounting for multiple comparisons.
Anti-seizure Medications