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Cenobamate as an Early Adjunctive Treatment in Drug-Resistant Focal-Onset Seizures: An Observational Cohort Study.
- Source :
-
CNS drugs [CNS Drugs] 2024 Sep; Vol. 38 (9), pp. 733-742. Date of Electronic Publication: 2024 Aug 03. - Publication Year :
- 2024
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Abstract
- Background and Objectives: Cenobamate (CNB) is a new antiseizure medication (ASM) to treat drug-resistant, focal-onset seizures. Data on its use in early therapy lines are not yet available, and clinicians frequently consider CNB to be a later ASM drug choice. We investigated the efficacy and safety of CNB as an early adjunctive treatment in drug-resistant, focal-onset seizures.<br />Methods: The study population were patients with drug-resistant, focal-onset seizures who were initiated with CNB after they did not respond to two or three lifetime ASMs, including all prior and concomitant ASMs. These patients were matched (1:2) by sex, age, and seizure frequency to controls who were initiated with any ASM other than CNB. All participants participated in the Mainz Epilepsy Registry. We evaluated the retention rate after 12 months of CNB and after each new adjunctive ASM in the control group. In addition, seizure freedom and the response rate (reduction of seizure frequency by ≥ 50% from baseline) after 12 months were estimated.<br />Results: We included 231 patients aged 44.4 ± 15.8 years. Of these, 33.3% (n = 77) were on CNB, 19.0% (n = 44) on valproate (VPA), 17.3% (n = 40) on lacosamide (LCS), 16.4% (n = 38) on levetiracetam (LEV), and 13.9% (n = 32) on topiramate (TPM). The highest retention rate after 12 months since the beginning of the early adjunctive therapy was observed on CNB (92.0%), compared with LCS (80.0%), LEV (73.3%), VPA (68.2%), or TPM (62.5%) (p < 0.05). Seizure freedom and response rate were also the best on CNB (19.5% and 71.4%, respectively) compared with other ASMs (8.3% and 52.5%, respectively; p < 0.05). No significant differences in adverse events between CNB and other ASMs were observed.<br />Conclusions: Our study provides evidence that CNB is an effective ASM with a good safety profile in the early therapy lines of drug-resistant, focal-onset seizures. This data should support medical decision making in the management of patients with refractory epilepsy.<br />Clinical Trial Id: NCT05267405.<br /> (© 2024. The Author(s).)
- Subjects :
- Humans
Male
Female
Adult
Middle Aged
Cohort Studies
Treatment Outcome
Tetrazoles administration & dosage
Tetrazoles therapeutic use
Tetrazoles adverse effects
Valproic Acid therapeutic use
Valproic Acid administration & dosage
Valproic Acid adverse effects
Anticonvulsants administration & dosage
Anticonvulsants therapeutic use
Anticonvulsants adverse effects
Carbamates therapeutic use
Carbamates adverse effects
Carbamates administration & dosage
Drug Resistant Epilepsy drug therapy
Drug Therapy, Combination
Seizures drug therapy
Chlorophenols administration & dosage
Chlorophenols adverse effects
Chlorophenols therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1179-1934
- Volume :
- 38
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- CNS drugs
- Publication Type :
- Academic Journal
- Accession number :
- 39096467
- Full Text :
- https://doi.org/10.1007/s40263-024-01109-9