A prospective analysis of the outcome of levetiracetam in clinical practice

Nicolson, Andrew; Lewis, Sheila; Smith, David F.

doi:10.1212/01.wnl.0000133214.78602.b3

Cited by 34 publications

(29 citation statements)

References 11 publications

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“…This is higher than in previous analyses (58-60% at 1-3 years) (14)(15)(16). This is higher than in previous analyses (58-60% at 1-3 years) (14)(15)(16).…”

Section: Discussioncontrasting

confidence: 73%

Clinical predictors in patients with refractory epilepsy exposed to levetiracetam: a single-center study

Peltola

Auvinen

et al. 2008

Acta Neurol Scand

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“…This is higher than in previous analyses (58-60% at 1-3 years) (14)(15)(16). This is higher than in previous analyses (58-60% at 1-3 years) (14)(15)(16).…”

Section: Discussioncontrasting

confidence: 73%

Clinical predictors in patients with refractory epilepsy exposed to levetiracetam: a single-center study

Peltola

Auvinen

et al. 2008

Acta Neurol Scand

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“…The post-marketing studies had a similar conclusion (Abou-Khalil and Lazenby 2003; Betts et al 2003; Ben-Menachem and Gilland 2003; Nicolson et al 2004; Depondt et al 2006; Kuba et al 2006). The retention rates at 1 year varied from 61% to 77% and seizure freedom rate varied from 16% to 26%.…”

Section: Levetiracetamsupporting

confidence: 62%

Levetiracetam in the treatment of epilepsy

Abou‐Khalil

2008

NDT

204

136

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Epilepsy is a common chronic disorder that requires long-term antiepileptic drug therapy. Approximately one half of patients fail the initial antiepileptic drug and about 35% are refractory to medical therapy, highlighting the continued need for more effective and better tolerated drugs. Levetiracetam is an antiepileptic drug marketed since 2000. Its novel mechanism of action is modulation of synaptic neurotransmitter release through binding to the synaptic vesicle protein SV2A in the brain. Its pharmacokinetic advantages include rapid and almost complete absorption, minimal insignifi cant binding to plasma protein, absence of enzyme induction, absence of interactions with other drugs, and partial metabolism outside the liver. The availability of an intravenous preparation is yet another advantage. It has been demonstrated effective as adjunctive therapy for refractory partial-onset seizures, primary generalized tonic-clonic seizures, and myoclonic seizures of juvenile myoclonic epilepsy. In addition, it was found equivalent to controlled release carbamazepine as fi rst-line therapy for partial-onset seizures, both in effi cacy and tolerability. Its main adverse effects in randomized adjunctive trials in adults have been somnolence, asthenia, infection, and dizziness. In children, the behavioral adverse effects of hostility and nervousness were also noted. Levetiracetam is an important addition to the treatment of epilepsy.

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“…Retention rates are similar to those reported in other smaller studies. 8 The Kaplan-Meier analysis estimated a retention rate of 58% at 3 years, although numbers at this stage were small (n = 12). We previously reported 3 year retention rates of 30% for topiramate, 29% for lamotrigine, and ,10% for gabapentin in patients recruited from the same epilepsy clinics.…”

Section: Discussionmentioning

confidence: 96%

The long term retention of levetiracetam in a large cohort of patients with epilepsy

Depondt

Yuen²,

Bell³

et al. 2006

Journal of Neurology, Neurosurgery & Psychiatry

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Levetiracetam (Lev) is a new antiepileptic drug with a distinct mechanism of action, shown in regulatory trials to be effective. These controlled trials do not always predict how useful a drug will be in day to day clinical practice. Retention rates can provide a better indication of efficacy and tolerability in everyday use. Patients attending a tertiary referral centre for epilepsy and who received Lev in the first 2 years of its marketing were assessed (n = 811) to determine continuation rates of treatment with this drug. At the last follow up, 65% of patients were still taking Lev, and the estimated 3 year retention rate was 58%. In total, 11% attained seizure freedom of at least 6 months. Patients taking greater numbers of concurrent antiepileptic drugs (AEDs) were more likely to discontinue Lev, and those reaching higher maximum daily dosages were less likely to discontinue Lev. The retention rate for Lev compares favourably with that of other new AEDs. L evetiracetam (Lev) is one of several antiepileptic drugs (AEDs) that have recently emerged for the adjunctive treatment of focal onset epilepsy. It was licensed as add on treatment for refractory focal epilepsy in adults in the UK in 2000. Lev is an S renantiomer pyr-olidone derivative with a distinctive pharmacological profile in animal models of seizures and epilepsy.1 It is not affected by drug-drug interactions and has a generally mild side effect profile. Lev was recently shown to act through binding to and modulation of the synaptic vesicle protein SV2A, 2 which is thought to play a crucial role in vesicle function. Thus, Lev is fundamentally different from other AEDs, and its efficacy and tolerability profiles may also differ.There are issues regarding the efficacy and safety of new AEDs, which have not been identified in regulatory trials.3 In total, 11 new AEDs have been licensed worldwide in the past 20 years, of which three (progabide, felbamate, and vigabatrin) developed safety problems, requiring prompt recall of patients to minimise morbidity. 4 These problems developed after launch despite years of clinical trials, indicating the need for close monitoring of people exposed to such drugs, both to identify potential problems and to enable swift recall of patients. Additionally, it has transpired that some of these new AEDs have had little clinical impact, and now have only a small role in the treatment of people with epilepsy. It is important, therefore, that the clinical efficacy profile of these drugs in every day use is identified early, to instruct good clinical practice and thereby to improve the quality of life and wellbeing of people with epilepsy.While the efficacy and tolerability of Lev have been demonstrated in several controlled regulatory trials, few studies have addressed long term continuation in a large group of patients in a clinic setting. This assessment aimed to determine the long term retention of treatment with Lev as a surrogate for efficacy and safety in a large group of patients in a single centre, to inform our futur...

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A prospective analysis of the outcome of levetiracetam in clinical practice

Cited by 34 publications

References 11 publications

Clinical predictors in patients with refractory epilepsy exposed to levetiracetam: a single-center study

Clinical predictors in patients with refractory epilepsy exposed to levetiracetam: a single-center study

Levetiracetam in the treatment of epilepsy

The long term retention of levetiracetam in a large cohort of patients with epilepsy

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