Cenobamate for the Treatment of Focal Epilepsy: A Retrospective Analysis of a Single Center Experience
Abstract number :
1.418
Submission category :
7. Anti-seizure Medications / 7C. Cohort Studies
Year :
2024
Submission ID :
765
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Itai Loushy, MD – Thomas Jefferson University
Lilach Goldstein, MD – Thomas Jefferson University
Kathryn Devlin, PhD – Drexel University
Anna Volski, MD – Thomas Jefferson University
Elizabeth Fletman, MD – Thomas Jefferson University
Juan Luis Alcala-Zermeno, MD – Columbia University
Louis Porreca, MD – Thomas Jefferson University
Michael Sperling, MD – Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Rationale: This study assesses the efficacy, safety, and tolerability of cenobamate using long-term real-world-data, utilizing a novel analytical method, incorporating both seizure reduction and periods of seizure freedom, while examining baseline clinical variables to help recognize predictors of response.
Methods: We conducted a retrospective analysis of all patients who were prescribed cenobamate from May 2020 to July 2021. Primary outcome was seizure frequency reduction at 12 months for each seizure type, stratified by baseline seizure frequency (higher frequency: ≥2 seizures in the preceding 3 months; lower frequency: < 2 seizures in the preceding 3 months). Logistic regression was employed to identify potential predictors of seizure response. Additionally, we assessed the longest period of seizure freedom, considering seizure type and baseline seizure frequency, further differentiating the higher-frequency group into weekly and monthly subgroups. We also examined retention, safety, and tolerability.
Results: Of 182 patients taking cenobamate, 170 had focal epilepsy. Among those 170 we observed a 12-month retention rate of 82.4%, decreasing to 75% at last follow-up. In patients with higher-frequency seizures at baseline, response rates were 47% for focal impaired awareness seizures (FIAS) and 58% for focal to bilateral tonic-clonic seizures (FBTCS). In patients with lower-frequency seizures, they were 53% for FIAS and 68% for FBTCS. Rates of seizure-free periods for ≥12 months were markedly influenced by baseline seizure frequency, with rates varying from 7-43% for seizures affecting awareness, and 17-56% for FBTCS, where patients with higher baseline frequencies had lower rates of seizure freedom. Factors linked to increased seizure freedom rates were lower baseline seizure frequency, fewer failed prior medications, and concomitant clobazam use. Most patients achieving seizure freedom did so at a 200 mg/day dose, although higher doses also showed efficacy, particularly for FBTCS. Adverse effects were reported by 52%, with drowsiness being the most common (32%), with one instance of depression necessitating hospitalization.
Conclusions: Our findings affirm cenobamate's robust efficacy and tolerability profile and demonstrate previously unknown clinical features associated with more favorable response.
Funding: Non funded study
Anti-seizure Medications