https://doi.org/10.55788/d48d030a
Simplification of therapy can help improve tolerability and adherence in general, and in drug-resistant epilepsy in particular. The current study, presented by Dr Juan Sanchez-Caro (Advanced Neurology Center, Spain), was triggered by another Spanish study of cenobamate in patients with drug-resistant epilepsy, showing a high response regardless of prior and concomitant medication [1,2]. As 1 of the partaking centres, the Advanced Neurology Center in Seville decided to further describe the results of the participants from their hospital, focusing on the possibility of rapidly reducing co-medications when prescribing cenobamate [2].
The study included 34 participants, 21 reached 12 months of follow-up. Cenobamate titration started at 12.5 mg/day, with an initial target of 200 mg/day and allowing further optimisation. After 3 months (n=32), the mean cenobamate dosage was 208 mg, after 12 months it was 326 mg. Participants could significantly decrease the use of concomitant anti-seizure drugs while on cenobamate: from a mean 3.6 defined daily dose (DDD) at baseline to 1.4 DDD after 12 months (P<0.001). Most of the co-medications were taken above the DDD at baseline, but all dosages were reduced, on average by >60%. Often, participants terminated co-medication altogether. For example, after 12 months, 40% had terminated carbamazepine use and 80% had stopped using lacosamide. The mean number of concomitant anti-seizure drugs decreased from 2.9 at baseline to 1.6 at 12 months (see Figure).
Optimising the use of cenobamate and minimising the use of co-medication had a significant effect on seizure frequency. At baseline, the mean number of seizures was 57.8 per month; this was reduced to 5.6 after 12 months. This amounted to a >50% seizure reduction by 18 participants (85.7%) at 12 months, and seizure freedom was achieved by 7 participants (33.3%). The number needed to treat (NNT) to reach a >75% reduction in seizure rate was 1.4 (1.86 in the intention-to-treat analysis).
Finally, the investigated approach also had a significant effect on adverse events (AEs). At baseline, AEs were frequent and included ataxia (35%), dizziness (53%), and somnolescence (65%), but these decreased significantly at 12 months (ataxia 4%, dizziness 10%, drowsiness 30%). No skin rash was detected.
The authors concluded that introducing rapid co-medication reduction while increasing cenobamate dose may be the necessary approach to optimise its efficacy and tolerability, and to improve the quality-of-life for patients with highly refractory epilepsy.
Figure: Number of concomitant anti-seizure drugs between baseline and month 12 [2]
- Villanueva V, et al. Epilepsia Open. 2023; May 7. Doi: 10.1002/epi4.12757.
- Sanchez-Caro J, et al. Co-medication management: key to optimize the efficacy and tolerability of Cenobamate. EAN 2023 Annual Meeting, 1-4 July, Budapest, Hungary.
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Table of Contents: EAN 2023
Featured articles
Letter from the Editor
Alzheimerās disease and dementia: the road towards proactive and preventive care
Overarching Theme: Big Data
Contribution of genomics and genetics to personalised medicine
How big data can boost care for neurodegenerative disorders
COVID-19
Amantadine in early COVID-19 enhances recovery
SARS-CoV-2 vaccination in CIDP and MMN: more benefit than harm
Cerebrovascular Disease and Stroke
Intensive BP reduction associated with smaller haematoma
Cognition and Dementia
Towards cell biology of Alzheimerās disease
Epilepsy
Minimising co-medication optimises cenobamate efficacy in drug-resistant epilepsy
Headache and Pain
GLP-1 agonists induce weight loss and alleviate headache in idiopathic intracranial hypertension
Cannabis-based medicine does not beat placebo in central neuropathic pain
80% of patients reverse from chronic to episodic migraine on anti-CGRP antibodies
Multiple Sclerosis
Which patients can initially be treated with platform DMT?
Retinal layer thickness predicts disability accumulation in early RMS
Withdrawing DMF in early pregnancy does not increase relapse risk in pregnant patients with MS
Immunosenescence and MS: relevance to immunopathogenesis and treatment
Sleep Disorders
Nightmares during childhood linked to cognitive decline later in life
Sleep changes contribute to the pathogenesis of neurodegenerative diseases
Miscellaneous
EAN guidelines on the management of ALS
What neurologists should know about bladder and sexual problems
Laughing gas abuse often leads to polyneuropathy, myelopathy, and encephalopathy
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