Comparison of Seizure-Freedom Rates at 24 Months After Initiating Pharmacotherapy for Focal Epilepsy Using Different Generation Anti-Epilepsy Medications: Carbamazepine, Lamotrigine or Levetiracetam
Abstract number :
2.126
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2019
Submission ID :
2421573
Source :
www.aesnet.org
Presentation date :
12/8/2019 4:04:48 PM
Published date :
Nov 25, 2019, 12:14 PM
Authors :
Suresh Gurbani, Kaiser Permanente; Sirichai Chayasirisobhon, Kaiser Permanente; Aditya Gurbani, University of Southern California; Stephanie Tovar, Kaiser Permanente; Erika Pietzsch, Kaiser Permanente; Benjamin Spurgeon, Kaiser Permanente
Rationale: Since the 1990s, 20 new anti-epileptic drugs (AED) have been approved in USA. Prior to that carbamazepine (CBZ) was the preferred AED for focal epilepsy. The SANAD trial concluded that lamotrigine (LTG) was the drug of choice for the management of focal epilepsy1. The LaLiMo trial found levetiracetam (LEV) to be non-inferior to LTG in the management of newly diagnosed epilepsy2. At Kaiser Permanente we use single-source bioequivalent generic AEDs for initial pharmacotherapy of focal epilepsy. We compared efficacy and tolerability of CBZ, LTG and LEV in the treatment of newly diagnosed focal epilepsy at 24-month study period. Methods: This was a retrospective data analysis of 646 consecutive AED naïve patients who were started on pharmacotherapy with CBZ, LTG or LEV as an initial monotherapy between 2006 and 2012 for the management of new onset focal epilepsy at a community-based epilepsy center. For slow titration needed to minimize the risk of life-threatening events (Stevens Johnson syndrome and toxic epidermal necrolysis) with LTG, AED dosing regimen adjustments were allowed during the first 6 months. Efficacy (seizure-freedom) and tolerability of AED regimen at 24 months was determined by using Chi-square with p-value at < 0.05. Results: A total of 204 patients were treated with CBZ, 188 received LTG and 254 were given LEV. At the 24-month study period, seizure freedom was maintained in 134 (65.7%) in CBZ group, 125 (66.5%) in LTG group, and 184 (72.4%) in LEV group. At the same study period, dropout rate due to adverse events was 8.3% (17) in CBZ group, 9.6% (18) in LTG group, and 14.6% (37) in LEV group. For seizure-freedom rates, combined Chi-square value was 0.231 (not significant at p value < 0.05). There were no fatalities or hospital admissions due to side effects. Conclusions: No statistically significant difference in seizure-freedom rates was noted amongst single-source bioequivalent generic CBZ, LTG and LEV when used in AED naïve patients with focal epilepsy. These efficacy rates were comparable to those reported in the literature for brand name AEDs3. Absence of life-threatening events makes LEV the drug of choice in AED naïve patients with focal epilepsy. Funding: No funding
Clinical Epilepsy