Retention rates and successful treatment with antiseizure medications in newly-diagnosed epilepsy patients: Treatment of epilepsy with new generation ASMs

Abstract

Treatment for epilepsy primarily involves antiseizure medications

(ASMs), which can be characterized using the clinical data warehouse (CDW)

database. In this study, we compared retention rates and time to successful

treatment for various ASMs to reflect both efficacy and adverse effects in

patients with newly-diagnosed epilepsy.

We identified newly-diagnosed epilepsy patients with

ASM treatment for more than 12 months using CDW of a tertiary referral

hospital. Clinical characteristics were compared between groups with

successful and unsuccessful treatment. Cox regression analysis was

performed to evaluate independent variables of age, sex, comorbidities, and

attributes of ASM regimens.

Of 2515 eligible participants, 46.2% were successfully treated with

the first ASM regimen, and 74.7% with all ASM regimens with median time-totreatment success of 14 months. Participants with second-generation ASM as

the first ASM were more likely to be successfully treated with the first regimen

compared to first-generation (51.6% vs. 42.3%, p<0.001) and more

successfully treated (HR=1.26, 95% CI: 1.15-1.39). Overall, valproic acid was

the most common ASM across wide range of ages under 65 years, while

levetiracetam in patients over 65 years or lamotrigine in female adult patients.

Clinical factors associated with less favorable treatment outcomes included

renal disease (HR=0.78; 0.66-0.92), liver disease (0.65; 0.52-0.81),

depression (0.70; 0.57-0.84), and mechanical ventilation (0.58; 0.50-0.67).

Second-generation ASMs have the advantage of more successful

treatment with fewer ASM regimen changes compared with first-generation

drugs. Various comorbid conditions as well as age and sex should be

considered when selecting ASMs.