Human Epilepsy Project 2 (HEP2) data provide new insights into which antiepileptic drugs (ASMs) are well tolerated and may benefit people with refractory epilepsy, researchers say said at the annual meeting of the American Epilepsy Society in December.
HEP2, a prospective observational study, was designed to determine whether biomarkers and clinical features can predict disease outcome, progression, and response to treatment in patients with focal epilepsy.
Researchers recruited 146 patients from 10 epilepsy centers across the United States and followed them from 2016 through 36 months. The participant had focal epilepsy and at least he had failed 4 of her ASMs. The pre-survey mean duration of use included eight different ASMs.
Investigators collected information on demographics, medical history, seizure history, EEG and MRI results, and past and current ASM medication history. At the start of the study, the patient was taking at least one of her ASMs. Her 45 of the study subjects were diagnosed before her 10th birthday. Her mean age at baseline was 39.7 years.
“A third of people with epilepsy are prescribed various ASMs for more than 10 years and they do not reduce seizure frequency,” said Jacqueline A. French, MD, FAAN, professor of neurology at the Comprehensive Epilepsy Center. holds a PhD from the NYU Grossman School of Medicine and is Chief Medical/Innovation Officer for the Epilepsy Foundation, which sponsored this study.
“We want to know what attracts people. [become] Dr. French said: “We want to shorten the journey for these patients to find the right treatment and understand why some drugs work for some and others don’t.”
The HEP2 data includes information about which drugs participants tried and which they no longer took, and which drugs they were still taking when they entered the study, Dr. French said. .
In this analysis, among other findings, levetiracetam was the most commonly used ASM overall, with 92.5% reporting lifetime use, followed by lamotrigine at 74% and lacosamide at 67.1%. , carbamazepine at 56.2% and topiramate and zonisamine at 50% each. .
It is not surprising that levetricetam is the most commonly prescribed ASM over the lifetime of patients, but it is important to confirm that it is one of the drugs with the lowest chance of retention. , said Dr. French.
After starting ASM, 63.6% of participants continued to use eslicarbazepine. 60%, Brivaracetam. 57.5%, Clobazam. and 38 percent, zonisamide. Phenytoin had the lowest retention rate of 10.8%, while eslicarbazepine and brivaracetam were used less frequently and had higher retention rates. Finally, lacosamide and lamotrigine were relatively commonly used and had high retention rates, suggesting good clinical efficacy and tolerability.
Dr. France and Texas A&M medical student Ojas Potnis will present their findings at the AES conference and continue to analyze data from the HEP2 study.
“These patients have been followed for two years to see if anyone is having seizures and why,” Dr. French said.
Andreas V. Alexopoulos, M.D., M.P.H., Staff Physician and Director of the Neuroscience Course at the Cleveland Clinic Epilepsy Center and Lerner Institute, said: at Lerner College of Medicine.
“By systematically examining lifetime and current antiepileptic drug use in patients with drug-resistant epilepsy, we are able to catalog patterns of drug use. It may help us understand how we treat patients with drug-resistant focal epilepsy, and may provide lasting benefits.”
However, Alexopoulos says observational studies have their limitations. “Data quality in similar studies depends on proper documentation of medical records and recall of participants,” he said.
“It is essential to remember that the results of observational studies cannot be used to prove causality,” added Dr. Alexopoulos. study and extend its conclusions beyond the study cohort to a wider patient population. ”
Nonetheless, Dr. Alexopoulos said, “Such studies provide a platform that will allow us to identify specific clinical features and potential biomarkers that can be used in the future to predict disease course, outcome, and treatment response.” We can provide it,” he added.
Dr. French revealed that he received travel coverage from Angelini Pharma SpA, Cerevel, Clinical Education Alliance, NeuCyte Inc., Neurocrine, Praxis, and Xenon.
