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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

Incidence of adverse events during follow-up.a Total: total percentage of patients with at least one adverse event; compared with CBZ, *: P<0.05, **: P<0.01; compared with VPA, #: P<0.05, ##: P<0.01; compared with TPM, &: P<0.05, &&: P<0.01; CBZ: carbamazepine; VPA: valproate; LTG: lamotrigine; TPM: topiramate; OXC: oxcarbazepine.
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pone.0131566.g004: Incidence of adverse events during follow-up.a Total: total percentage of patients with at least one adverse event; compared with CBZ, *: P<0.05, **: P<0.01; compared with VPA, #: P<0.05, ##: P<0.01; compared with TPM, &: P<0.05, &&: P<0.01; CBZ: carbamazepine; VPA: valproate; LTG: lamotrigine; TPM: topiramate; OXC: oxcarbazepine.

Mentions: Overall, in terms of the percentage of patients with at least one AE in the 3-year observation period, CBZ was higher than VPA, LTG, and OXC (all P<0.05), and other paired comparisons showed no significant differences (Fig 4). Table 3 shows the AEs of each AED during three years. The neuropsychiatric symptoms whose common individual ones included dizziness/vertigo, memory deterioration, and insomnia were the most common in the five AEDs. For the individual symptoms, rash was a common early phase symptom with CBZ, LTG, and OXC; gastrointestinal reactions were very prevalent in each individual drug; liver dysfunction was a common AE of CBZ and VPA. Other common AEs were cytopenia (common with CBZ and VPA), weight change (common with VPA and TPM), kidney calculus (common with TPM), numbness (common with TPM), and tremor (common with VPA). In the first month (early phase), the AE incidence of VPA was the lowest, significantly lower than other four drugs (VPA vs. CBZ/LTG, P<0.01; VPA vs. TPM/OXC, P<0.05). The AE incidence of OXC was lower than that of CBZ (P<0.05), which was the highest in the early phase, and there were no significant difference between other pairwise comparisons. In 2–6 months (medium-term), the AE incidence of CBZ was the highest, significantly higher than that of VPA, LTG, and OXC (all P<0.01), and the one of TPM was also higher than that of LTG (P<0.05). No other paired comparisons of medium-term AE incidence showed a significant difference. In the 7–36 month interval (long-term), the AE incidence of TPM was the highest, all significantly higher than that of other drugs (TPM vs. VPA/LTG/OXC, P<0.01; TPM vs. CBZ, P<0.05) (Fig 4).


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)

Incidence of adverse events during follow-up.a Total: total percentage of patients with at least one adverse event; compared with CBZ, *: P<0.05, **: P<0.01; compared with VPA, #: P<0.05, ##: P<0.01; compared with TPM, &: P<0.05, &&: P<0.01; CBZ: carbamazepine; VPA: valproate; LTG: lamotrigine; TPM: topiramate; OXC: oxcarbazepine.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0131566.g004: Incidence of adverse events during follow-up.a Total: total percentage of patients with at least one adverse event; compared with CBZ, *: P<0.05, **: P<0.01; compared with VPA, #: P<0.05, ##: P<0.01; compared with TPM, &: P<0.05, &&: P<0.01; CBZ: carbamazepine; VPA: valproate; LTG: lamotrigine; TPM: topiramate; OXC: oxcarbazepine.
Mentions: Overall, in terms of the percentage of patients with at least one AE in the 3-year observation period, CBZ was higher than VPA, LTG, and OXC (all P<0.05), and other paired comparisons showed no significant differences (Fig 4). Table 3 shows the AEs of each AED during three years. The neuropsychiatric symptoms whose common individual ones included dizziness/vertigo, memory deterioration, and insomnia were the most common in the five AEDs. For the individual symptoms, rash was a common early phase symptom with CBZ, LTG, and OXC; gastrointestinal reactions were very prevalent in each individual drug; liver dysfunction was a common AE of CBZ and VPA. Other common AEs were cytopenia (common with CBZ and VPA), weight change (common with VPA and TPM), kidney calculus (common with TPM), numbness (common with TPM), and tremor (common with VPA). In the first month (early phase), the AE incidence of VPA was the lowest, significantly lower than other four drugs (VPA vs. CBZ/LTG, P<0.01; VPA vs. TPM/OXC, P<0.05). The AE incidence of OXC was lower than that of CBZ (P<0.05), which was the highest in the early phase, and there were no significant difference between other pairwise comparisons. In 2–6 months (medium-term), the AE incidence of CBZ was the highest, significantly higher than that of VPA, LTG, and OXC (all P<0.01), and the one of TPM was also higher than that of LTG (P<0.05). No other paired comparisons of medium-term AE incidence showed a significant difference. In the 7–36 month interval (long-term), the AE incidence of TPM was the highest, all significantly higher than that of other drugs (TPM vs. VPA/LTG/OXC, P<0.01; TPM vs. CBZ, P<0.05) (Fig 4).

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