Literature Review Compares Efficacy of 12 Antiepileptic Refractory POS Drugs

Literature Review Compares Efficacy of 12 Antiepileptic Refractory POS Drugs
Literature Review Compares Efficacy of 12 Antiepileptic Refractory POS Drugs

VANCOUVER, BC—Adjunctive therapy with vigabatrin, tiagabine, or pregabalin for refractory complex partial-onset seizures (POS) is associated with superior reductions in seizure frequency compared to other antiepileptic drugs (AEDs), according to authors of a systematic literature review presented at the 68th AAN Annual Meeting.

“Patients receiving pregabalin, tiagabine, and vigabatrin had the highest pooled odds versus placebo of experiencing a ≥50% reduction in seizures,” wrote lead author Jeremy Slater, MD, University of Texas Health Science Center, Houston, TX, and coauthors, in a poster presentation.

“Patients receiving ezogabine, levetiracetam, and vigabatrin had the highest pooled odds versus placebo of achieving seizure freedom,” they also reported.

Placebo-controlled clinical trials have helped to quantify AED efficacies for POS, but scant heat-to-head comparison trials have been reported. “It is therefore of interest to compare the efficacy of all current AEDs approved for adjunctive treatment of refractory POS, using a pragmatic study design that incorporates the pivotal trials that were used to obtain U.S. Food and Drug Administration (FDA) drug approval,” the poster coauthors explained.

They therefore compared FDA-approved AEDs' relative efficacies for refractory POS in a systematic review and meta-analysis of data pooled from 30 pivotal trials, representing studies of 12 AEDs, the researchers reported.

“Compared with placebo, the pooled odds of patients experiencing a ≥50% reduction in seizure frequency increased 6.23 with vigabatrin (3000mg/day), 8.08 with pregabalin (600mg/day), and 8.82 with tiagabine (56mg/day),” they reported.

The pooled odds for seizure freedom “were at least 7 times greater for patients receiving levetiracetam (3000mg/day), vigabatrin (3000mg/day), and ezogabine (1200mg/day) than placebo,” they added.

Adverse events-associated treatment discontinuation rates were higher than placebo for all AEDs other than pregabalin, they noted. However, the data analyzed did not include long-term adverse effects, they cautioned. “This meta-analysis was limited to studies that reported the 50% responder rate, seizure freedom, or discontinuation rate due to AEs.”

Dr. Slater disclosed receiving speaking fees from UCB Pharma and Lundbeck LLC, which funded the study.   

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