Magazine article Clinical Psychiatry News

Data Help Prioritize Drugs for Treating Epilepsy

Magazine article Clinical Psychiatry News

Data Help Prioritize Drugs for Treating Epilepsy

Article excerpt

The results of two large British trials that followed epilepsy patients for several years indicate that lamotrigine should be the drug of first choice for people with partial epilepsy and that valproate should be the drug of first choice for people with generalized and unclassifiable epilepsy, investigators reported.

The two Standard and New Antiepileptic Drugs (SANAD) studies were unblinded, randomized, controlled studies conducted in hospital-based outpatient clinics in the United Kingdom.

One study compared the established epilepsy drug carbamazepine with gabapentin, lamotrigine, oxcarbazepine, and topiramate in 1,721 patients with at least two clinically definite, unprovoked epileptic seizures in the previous year. The study included newly diagnosed patients, those who had failed monotherapy and those who had gone into remission but relapsed after treatment was stopped. Their mean age was 38-40 years, and they were followed for up to 6 years, wrote Dr. Anthony G. Marson of the University of Liverpool (England) and his associates.

Patients taking lamotrigine had significantly longer time to treatment failure for any reason (inadequate seizure control or unacceptable adverse events) than did those taking the standard treatment carbamazepine and the newer drugs gabapentin and topiramate, the authors reported. Lamotrigine had an advantage over oxcarbazepine, but it was not significant.

For time elapsed before achieving 12 months of remission, carbamazepine was significantly better than gabapentin. Their analyses suggested there was a nonsignificant advantage for carbamazepine over lamotrigine, topiramate, and oxcarbazepine for this end point. Lamotrigine, they noted, was considered "noninferior" to carbamazepine for 12-month remission from seizures, they added.

"Although there might be circumstances where other drugs are preferred (consideration of teratogenicity, bone health, drug interactions), the better tolerability seen in lamotrigine than carbamazepine, with noninferiority of longer-term efficacy outcomes, lends support to lamotrigine as first-choice treatment for most patients with partial epilepsy," the authors concluded (Lancet 2007;369:1000-15).

The second SANAD study enrolled 716 patients (mean age 22 years) with generalized onset seizures and seizures that were difficult to classify. Valproate, which the authors said is considered the standard treatment for these patients, was compared with lamotrigine or topiramate for up to 7 years. …

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