Long‐Term Retention Rates of Lamotrigine, Gabapentin, and Topiramate in Chronic Epilepsy

Lhatoo, Samden D.; Wong, Ian Chi Kei; Polizzi, Gaetano; Sander, JW

doi:10.1111/j.1499-1654.2000.001592.x

Cited by 53 publications

(8 citation statements)

References 3 publications

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“…This finding was in contrast to what was found by SANAD study, in which valproate and topiramate showed same treatment failure rate as a result of LE. In addition, our study showed that the LE, rather than AE is the most frequently precipitant for the discontinuations of SRVPA and topiramate, which is not consistent with other reports [12], [17], [20]. Compared with those studies, our study employed lower initial dosages and slower titration, and had longer time of follow-up.…”

Section: Discussioncontrasting

confidence: 95%

“…It was assumed that the treatment failure for SRVPA and topiramate were 25% and 35% after one year, respectively [16], [17]. In this study, SRVPA was considered as an active comparator, there needed 415 patients for each group to achieve 90% power (β = 0.1) at a 0.05 significance level to detect an equivalence hazard ratio of 1.35, assuming a dropout rate of 20% for both groups during the whole study.…”

Section: Methodsmentioning

confidence: 99%

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Outcomes of Sustained-Release Formulation of Valproate and Topiramate Monotherapy in Patients with Epilepsy: A Multi-Centre, Cohort Study

Huang

Shen

et al. 2012

PLoS ONE

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BackgroundNew-generation antiepileptic drugs (AEDs) tend to replace traditional AEDs as the first-line choice for epilepsy. However, whether this change results in better outcome, especially in China, remains unknown.Methodology/Principal FindingsTwo broad spectrum AEDs, the traditional drug of sustained-release formulation of valproate (SRVPA) and the new-generation drug of topiramate, were compared in patients with epilepsy as monotherapy in this multi-centre, observational cohort study from 2000 to 2011. The primary outcome was time to treatment failure. The secondary outcomes included time to first seizure, time to 12-month remission, and time to 24-month remission. Drug tolerability was assessed. Cox proportional hazard models (95% confidence interval [CI]) were used to analyse the relative risks expressed as hazard ratios (HR).Of the 1008 recruited patients, 519 received SRVPA and 489 received topiramate. SRVPA was better than topiramate (28.3% vs. 41.5%; HR = 0.62, [95% CI 0.49–0.77]; p<0.0001) in primary outcome, and in time to first seizure (56.1% vs. 69.3%; HR = 0.73, [95% CI 0.62–0.86]; p = 0.0002). No significant difference was observed between two groups in time to 12-month remission (52.6% vs. 42.5%; HR = 1.01, [95% CI 0.84–1.23]; p = 0.88) and time to 24-month remission (34.7% vs. 25.2%; HR = 1.11, [95% CI 0.88–1.42]; p = 0.38). 36 patients (6.9%) in SRVPA group and 37 patients (7.6%) in topiramate group presented treatment failure associated with intolerable adverse events, there was no significant difference between the two groups (p = 0.70).ConclusionsThe SRVPA is more suitable than topiramate for Chinese epileptic patients, and our results support the viewpoint that traditional AEDs should be the first-line choice for epilepsy rather than new-generation AEDs.

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Section: Discussioncontrasting

confidence: 95%

Section: Methodsmentioning

confidence: 99%

Outcomes of Sustained-Release Formulation of Valproate and Topiramate Monotherapy in Patients with Epilepsy: A Multi-Centre, Cohort Study

Huang

Shen

et al. 2012

PLoS ONE

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“…As such, medication retention is considered one of the most relevant measures of the overall performance of an antiepileptic drug. 47–49 While medication retention has historically been measured as the proportion of patients continuing therapy at a set time point following treatment initiation, examining more detailed components of drug retention as we did here, may provide insights into specific aspects of a drug’s performance. For example, we found similar proportions of patients resuming therapy after treatment discontinuation, indicating that the tolerability of the two drug groups are likely comparable.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Drug Utilization Patterns in Observational Data: Antiepileptic Drugs in Pediatric Patients

et al. 2015

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Purpose Physicians require information on the comparative benefits and harms of medications for optimal treatment decisions. However, this type of data is limited, especially for pediatric patients. Objective Our aim was to use observational data to measure and compare medication utilization patterns in a pediatric patient population. Methods Using pharmacy claims data from a large, national-scale insurance program in the US, we identified all patients with a diagnosis of epilepsy treated with a first-generation (carabamazepine, ethosuximide, phenobarbital, phenytoin, valproate) or second-generation (carbamazepine XR, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabine, topiramate, valproate XR, zonisamide) antiepileptic drug. Treatment periods were defined based on prescription fill dates and medication days supplied. Medication use was measured for individual antiepileptic drugs and for first-generation and second-generation drugs as groups. Results There were 2527 (54%) patients who initiated therapy with first-generation and 2139 (46%) with second-generation antiepileptics. First- and second-generation drugs had the same one-year retention rates (26% [95%CI 24–28] and 26% [95%CI 25–28], respectively). A total of 26% (95%CI 25–28) and 29% (95%CI 27–31) of patients who started on a first- or second-generation antiepileptic medication, respectively, resumed treatment with the initial drug after discontinuation. Overall, 73% (95%CI 71–74) of patients were treated with only one antiepileptic drug, with similar rates for patients started on first- and second-generation drugs (71% [95%CI 69–73] vs 74% [95%CI 72–76]). Conclusions Comparing drug utilization patterns in a pediatric population using observational data, we found similar rates of retention and therapeutic changes. These findings are consistent with available comparative data and demonstrate an approach that could be extended to other drug classes and conditions in pediatric populations to examine drug effectiveness.

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“…Selection bias could not be avoided in comparing effectiveness of AEDs in clinical practice. Therefore potential confounding factors should be excluded in using Cox regression model during multivariate analysis, allowing for a more scientific comparison of different AEDs [ 18 , 33 ]. Cox proportional hazards models (95% confidence interval [CI]) were employed to analyze the hazard ratios (HRs).…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2015

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ObjectiveTo evaluate and compare long-term effectiveness of five antiepileptic drugs (AEDs) for monotherapy of adult patients with focal epilepsy in routine clinical practice.MethodsAdult 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.ResultsThis 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]).ConclusionLTG 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.

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Long‐Term Retention Rates of Lamotrigine, Gabapentin, and Topiramate in Chronic Epilepsy

Cited by 53 publications

References 3 publications

Outcomes of Sustained-Release Formulation of Valproate and Topiramate Monotherapy in Patients with Epilepsy: A Multi-Centre, Cohort Study

Outcomes of Sustained-Release Formulation of Valproate and Topiramate Monotherapy in Patients with Epilepsy: A Multi-Centre, Cohort Study

Comparison of Drug Utilization Patterns in Observational Data: Antiepileptic Drugs in Pediatric Patients

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

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