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Comparative Long-Term Effectiveness of a Monotherapy with Five Antiepileptic Drugs for Focal Epilepsy in Adult Patients: A Prospective Cohort Study.

Zeng QY, Fan TT, Zhu P, He RQ, Bao YX, Zheng RY, Xu HQ - PLoS ONE (2015)

Bottom Line: For time to treatment failure, LTG was significantly better than CBZ and VPA (LTG vs.LTG was significantly better than CBZ (1.44 [1.15-1.82]) and OXC (LTG vs.OXC, 0.76 [0.63-0.93]); OXC was less effective than LTG in preventing the first seizure (1.20 [1.02-1.40]).

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, P.R. China.

ABSTRACT

Objective: To evaluate and compare long-term effectiveness of five antiepileptic drugs (AEDs) for monotherapy of adult patients with focal epilepsy in routine clinical practice.

Methods: Adult patients with focal epilepsy, who were prescribed with carbamazepine (CBZ), valproate (VPA), lamotrigine (LTG), topiramate (TPM), or oxcarbazepine (OXC) as monotherapy, during the period from January 2004 to June 2012 registered in Wenzhou Epilepsy Follow Up Registry Database (WEFURD), were included in the study. Prospective long-term follow-up was conducted until June 2013. The endpoints were time to treatment failure, time to seizure remission, and time to first seizure.

Results: This study included 654 patients: CBZ (n=125), VPA (n=151), LTG (n=135), TPM (n=76), and OXC (n=167). The retention rates of CBZ, VPA, LTG, TPM, and OXC at the third year were 36.1%, 32.4%, 57.6%, 37.9%, and 41.8%, respectively. For time to treatment failure, LTG was significantly better than CBZ and VPA (LTG vs. CBZ, hazard ratio, [HR] 0.80 [95% confidence interval: 0.67-0.96], LTG vs. VPA, 0.53 [0.37-0.74]); TPM was worse than LTG (TPM vs. LTG, 1.77 [1.15-2.74]), and OXC was better than VPA (0.86 [0.78-0.96]). After initial target doses, the seizure remission rates of CBZ, VPA, LTG, TPM, and OXC were 63.0%, 77.0%, 83.6%, 67.9%, and 75.3%, respectively. LTG was significantly better than CBZ (1.44 [1.15-1.82]) and OXC (LTG vs. OXC, 0.76 [0.63-0.93]); OXC was less effective than LTG in preventing the first seizure (1.20 [1.02-1.40]).

Conclusion: LTG was the best, OXC was better than VPA only, while VPA was the worst. The others were equivalent for comparisons between five AEDs regarding the long-term treatment outcomes of monotherapy for adult patients with focal epilepsy in a clinical practice. For selecting AEDs for these patients among the first-line drugs, LTG is an appropriate first choice; others are reservation in the first-line but VPA is not.

No MeSH data available.


Related in: MedlinePlus

Retention rates of AEDs.Overall retention rate by Kaplan-Meier analysis (A) and Cox regression (B); Retention rate after treatment failure for AEs (C) and LE (D) by Cox regression; CBZ: carbamazepine; VPA: valproate; LTG: lamotrigine; TPM: topiramate; OXC: oxcarbazepine; AED: antiepileptic drug; AE: adverse event; LE: lack of efficacy; HR: hazard ratio; CI: confidence interval.
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pone.0131566.g002: Retention rates of AEDs.Overall retention rate by Kaplan-Meier analysis (A) and Cox regression (B); Retention rate after treatment failure for AEs (C) and LE (D) by Cox regression; CBZ: carbamazepine; VPA: valproate; LTG: lamotrigine; TPM: topiramate; OXC: oxcarbazepine; AED: antiepileptic drug; AE: adverse event; LE: lack of efficacy; HR: hazard ratio; CI: confidence interval.

Mentions: In the ITT analysis, the retention rates of CBZ, VPA, LTG, TPM, and OXC at the third year were 36.1%, 32.4%, 57.6%, 37.9%, and 41.8%, respectively (Fig 2A). For time to treatment failure, after adjustment for potential confounders by Cox proportional hazards models, LTG was significantly better than CBZ, VPA, and TPM (LTG vs. CBZ, 0.80 [0.67–0.96]; LTG vs. VPA, 0.53 [0.37–0.74]; TPM vs. LTG, 1.77 [1.15–2.74]). OXC was also better than VPA (0.86 [0.78–0.96]). There were no differences in pairwise comparison of retention rates between other AEDs (Fig 2B). The PP analysis showed similar results (LTG vs. CBZ, 0.78 [0.65–0.94]; LTG vs. VPA, 0.60 [0.42–0.85]; TPM vs. LTG, 1.67 [1.08–2.59]) except the comparison between OXC and VPA (OXC vs. VPA, 0.93 [0.84–1.02]) (S1 Fig).


Comparative Long-Term Effectiveness of a Monotherapy with Five Antiepileptic Drugs for Focal Epilepsy in Adult Patients: A Prospective Cohort Study.

Zeng QY, Fan TT, Zhu P, He RQ, Bao YX, Zheng RY, Xu HQ - PLoS ONE (2015)

Retention rates of AEDs.Overall retention rate by Kaplan-Meier analysis (A) and Cox regression (B); Retention rate after treatment failure for AEs (C) and LE (D) by Cox regression; CBZ: carbamazepine; VPA: valproate; LTG: lamotrigine; TPM: topiramate; OXC: oxcarbazepine; AED: antiepileptic drug; AE: adverse event; LE: lack of efficacy; HR: hazard ratio; CI: confidence interval.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493091&req=5

pone.0131566.g002: Retention rates of AEDs.Overall retention rate by Kaplan-Meier analysis (A) and Cox regression (B); Retention rate after treatment failure for AEs (C) and LE (D) by Cox regression; CBZ: carbamazepine; VPA: valproate; LTG: lamotrigine; TPM: topiramate; OXC: oxcarbazepine; AED: antiepileptic drug; AE: adverse event; LE: lack of efficacy; HR: hazard ratio; CI: confidence interval.
Mentions: In the ITT analysis, the retention rates of CBZ, VPA, LTG, TPM, and OXC at the third year were 36.1%, 32.4%, 57.6%, 37.9%, and 41.8%, respectively (Fig 2A). For time to treatment failure, after adjustment for potential confounders by Cox proportional hazards models, LTG was significantly better than CBZ, VPA, and TPM (LTG vs. CBZ, 0.80 [0.67–0.96]; LTG vs. VPA, 0.53 [0.37–0.74]; TPM vs. LTG, 1.77 [1.15–2.74]). OXC was also better than VPA (0.86 [0.78–0.96]). There were no differences in pairwise comparison of retention rates between other AEDs (Fig 2B). The PP analysis showed similar results (LTG vs. CBZ, 0.78 [0.65–0.94]; LTG vs. VPA, 0.60 [0.42–0.85]; TPM vs. LTG, 1.67 [1.08–2.59]) except the comparison between OXC and VPA (OXC vs. VPA, 0.93 [0.84–1.02]) (S1 Fig).

Bottom Line: For time to treatment failure, LTG was significantly better than CBZ and VPA (LTG vs.LTG was significantly better than CBZ (1.44 [1.15-1.82]) and OXC (LTG vs.OXC, 0.76 [0.63-0.93]); OXC was less effective than LTG in preventing the first seizure (1.20 [1.02-1.40]).

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, P.R. China.

ABSTRACT

Objective: To evaluate and compare long-term effectiveness of five antiepileptic drugs (AEDs) for monotherapy of adult patients with focal epilepsy in routine clinical practice.

Methods: Adult patients with focal epilepsy, who were prescribed with carbamazepine (CBZ), valproate (VPA), lamotrigine (LTG), topiramate (TPM), or oxcarbazepine (OXC) as monotherapy, during the period from January 2004 to June 2012 registered in Wenzhou Epilepsy Follow Up Registry Database (WEFURD), were included in the study. Prospective long-term follow-up was conducted until June 2013. The endpoints were time to treatment failure, time to seizure remission, and time to first seizure.

Results: This study included 654 patients: CBZ (n=125), VPA (n=151), LTG (n=135), TPM (n=76), and OXC (n=167). The retention rates of CBZ, VPA, LTG, TPM, and OXC at the third year were 36.1%, 32.4%, 57.6%, 37.9%, and 41.8%, respectively. For time to treatment failure, LTG was significantly better than CBZ and VPA (LTG vs. CBZ, hazard ratio, [HR] 0.80 [95% confidence interval: 0.67-0.96], LTG vs. VPA, 0.53 [0.37-0.74]); TPM was worse than LTG (TPM vs. LTG, 1.77 [1.15-2.74]), and OXC was better than VPA (0.86 [0.78-0.96]). After initial target doses, the seizure remission rates of CBZ, VPA, LTG, TPM, and OXC were 63.0%, 77.0%, 83.6%, 67.9%, and 75.3%, respectively. LTG was significantly better than CBZ (1.44 [1.15-1.82]) and OXC (LTG vs. OXC, 0.76 [0.63-0.93]); OXC was less effective than LTG in preventing the first seizure (1.20 [1.02-1.40]).

Conclusion: LTG was the best, OXC was better than VPA only, while VPA was the worst. The others were equivalent for comparisons between five AEDs regarding the long-term treatment outcomes of monotherapy for adult patients with focal epilepsy in a clinical practice. For selecting AEDs for these patients among the first-line drugs, LTG is an appropriate first choice; others are reservation in the first-line but VPA is not.

No MeSH data available.


Related in: MedlinePlus