Dermatology Precautions and Slower Titration Yield Low Incidence of Lamotrigine Treatment-Emergent Rash

Ketter, Terence A.; Wang, Po; Chandler, Rebecca A.; Alarcón, Andrea; Becker, Olga; Nowakowska, Cecylia; O'Keeffe, Colette; Schumacher, Matthew

doi:10.4088/jcp.v66n0516

Cited by 42 publications

(15 citation statements)

References 4 publications

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“…The overall frequency of adverse events in our study was 22.9% (104/455), with the most common adverse event being skin rash (13.7%; 61/445). The incidence of benign skin reactions in this study was higher than that observed in previous studies: between 8% and 11% by Ketter et al43 and 12.7% by Woo et al44 A recent meta-analysis showed an even lower rate of 7.2% (214/2,977 patients) in retrospective studies 45. The reason for this result could be the particular attention we paid to the onset of rashes; patients with the slightest sign of rash were withdrawn immediately at a physician’s discretion.…”

Section: Discussioncontrasting

confidence: 81%

Long-term efficacy and safety of lamotrigine for all types of bipolar disorder

Watanabe¹,

Hongō²

2017

NDT

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BackgroundWe investigated whether the long-term efficacy and safety of lamotrigine (LTG) for bipolar disorder (BP) differs between disease types (BP-I, BP-II, or BP not otherwise specified [BP-NOS]), and the efficacy of the concomitant use of antidepressants (ADs).MethodsFor >1 year, we observed 445 outpatients with BP (diagnosed by DSM-IV criteria) who initiated LTG treatment between July 1 and October 31, 2011, using the Himorogi Self-rating Depression (HSDS) and Anxiety Scales and the Clinical Global Impression-Improvement scale and also recorded adverse events.ResultsTreatment efficacy was observed at week 4, with the improved HSDS scores sustained until week 52 for all types of BP; 50% of the patients with any type of BP could be treated with LTG for 1 year, whereas ~40% could be treated for >1.5 years. However, 25% of the patients were withdrawn within the first 4 weeks. The overall incidence of adverse events was 22.9% (104/455): 34.1% (14/41) for BP-I, 22.7% (15/66) for BP-II, and 22.2% (75/338) for BP-NOS. The most common adverse event was skin rash: 22.0% for BP-I, 16.7% for BP-II, and 12.1% for BP-NOS.LimitationsThere was no control group. Data were collected retrospectively.ConclusionWith careful and adequate titration, long-term treatment with LTG is possible for any type of BP, with BP-NOS patients, the largest population in clinical practice, responding particularly well. Symptoms can improve with or without ADs. Large-scale prospective studies of the efficacy of ADs in bipolar treatment are warranted.

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Section: Discussioncontrasting

confidence: 81%

Long-term efficacy and safety of lamotrigine for all types of bipolar disorder

Watanabe¹,

Hongō²

2017

NDT

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“…With severe rash, desquamation or associated symptoms of fever or lymphadenopathy indicative of StevensJohnson syndrome requires prompt discontinuation. The slower the titration, the less likely it is that these side effects will occur, but most patients will not accept an overly cautious and long titration phase [Ketter et al 2005].…”

Section: Medical Treatmentmentioning

confidence: 99%

Treatment options in trigeminal neuralgia

Obermann

2010

Ther Adv Neurol Disord

175

133

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The incidence of trigeminal neuralgia (TN) is 4.3 per 100,000 persons per year, with a slightly higher incidence for women (5.9/100,000) compared with men (3.4/100,000). There is a lack of certainty regarding the aetiology and pathophysiology of TN. The treatment of TN can be very challenging despite the numerous options patients and physicians can choose from. This multitude of treatment options poses the question as to which treatment fits which patient best. The preferred medical treatment for TN consists of anticonvulsant drugs, muscle relaxants and neuroleptic agents. Large-scale placebo-controlled clinical trials are scarce. For patients refractory to medical therapy, Gasserian ganglion percutaneous techniques, gamma knife surgery and microvascular decompression are the most promising invasive treatment options.

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“…Well-known risk factors for lamotrigine-related skin rash include a high initial dosage, rapid titration of dosage, and concurrent valproic acid administration 31. Clinical trials aimed at reducing the incidence of lamotrigine-related skin rash found that slower titration and lowering of the starting dosage were effective in preventing the development of skin rash 323334. We similarly consider that it may be beneficial to initially apply a very low dosage and then only gradually escalate it in patients who have experienced adverse drug reactions.…”

Section: Discussionmentioning

confidence: 99%

Desensitization to Oxcarbazepine: Long-Term Efficacy and Tolerability

et al. 2017

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Background and PurposeAntiepileptic drug (AED)-associated cutaneous adverse drug reactions can lead to the discontinuation of medications. The aim of this study was to determine the long-term efficacy and safety of performing desensitization to oxcarbazepine.MethodsThis study involved 20 patients who exhibited cutaneous adverse drug reactions associated with oxcarbazepine use between July 2009 and March 2016 at Samsung Medical Center. All of the participants had to discontinue oxcarbazepine despite presenting initially positive responses. Human leukocyte antigen genotyping was performed to detect the genetic predisposition to Stevens-Johnson syndrome. The desensitization to oxcarbazepine was performed with a starting dosage of 0.1 mg/day. Efficacy was evaluated by comparing the frequency of seizures before and at 1 and 3 years after desensitization. Adverse events occurring during desensitization and the retention rate after desensitization were also investigated.ResultsNineteen patients (95%) safely completed the desensitization protocol. One withdrew owing to emotional problems that appeared to be associated with oxcarbazepine. The follow-up period was 4.6±1.2 years (mean±SD), and oxcarbazepine was maintained for more than 3 years after desensitization in 15 patients (83.3%). The response rates were 84.2% and 77.8% at 1 and 3 years after desensitization, respectively. Eight patients remained seizure-free for 3 years, and two discontinued all AEDs. Transient adverse reactions such as mild rash and itching were reported by five patients during desensitization.ConclusionsThis study has demonstrated the long-term efficacy and safety of desensitization to oxcarbazepine in patients exhibiting cutaneous adverse drug reactions. This favorable outcome should encourage the implementation of desensitization in patients presenting with hypersensitivity to oxcarbazepine as an alternative strategy in clinical practice.

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Dermatology Precautions and Slower Titration Yield Low Incidence of Lamotrigine Treatment-Emergent Rash

Cited by 42 publications

References 4 publications

Long-term efficacy and safety of lamotrigine for all types of bipolar disorder

Long-term efficacy and safety of lamotrigine for all types of bipolar disorder

Treatment options in trigeminal neuralgia

Desensitization to Oxcarbazepine: Long-Term Efficacy and Tolerability

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