Abstracts

Rationale: Antiseizure medications (ASMs) are rarely compared directly in clinical trials. An indirect treatment comparison (ITC) can ascertain how ASMs fare against each other, providing valuable information to guide appropriate prescribing. Prior ITCs did not find differences between adjunctive ASMs for efficacy in focal epilepsy (Thieffry S, et al. Epilepsia. 2020;61(4):595-609). Cenobamate is an ASM approved in the US for treatment of focal (partial-onset) seizures in adults. An ITC was performed to compare efficacy and safety of adjunctive cenobamate vs adjunctive therapy with a group of 7 other ASMs.

Methods: A systematic literature review was conducted to identify randomized, double-blind, placebo-controlled trials (maintenance phase ≥12 weeks) assessing adjunctive ASMs in adults with uncontrolled focal seizures. Trial arms were combined to estimate ASM-specific effects from eligible studies, and then combined placebo-adjusted effects for specific ASM groups and doses were compared for the ≥50% responder rate and treatment-emergent adverse events (TEAEs) leading to ASM discontinuation using Bucher’s method. Cenobamate was compared to a group of 7 other ASMs, and to subgroups of branded (brivaracetam, eslicarbazepine acetate, lacosamide, perampanel) and older ASMs (lamotrigine, levetiracetam, topiramate) at FDA-recommended daily maintenance doses (FDA-RDMD) and all doses. Statistical significance was set at P < 0.05.