Efficacy of Valproic Acid in Comparison with Next Generation Anti-Seizure Medications in Epilepsy Patients; Database Analysis from an Epilepsy Center
Abstract number :
92
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2020
Submission ID :
2422440
Source :
www.aesnet.org
Presentation date :
12/5/2020 9:07:12 AM
Published date :
Nov 21, 2020, 02:24 AM
Authors :
Anum Riaz, University of Toledo College of Medicine; Sidra Saleem - Universty of Toledo COM; Ajaz Sheikh - University of Toledo, COM; Nurose Karim - University of Toledo COM; Maria Rabbani - University of Toledo COM; Hongyan Li - University of Toledo COM;
Rationale:
Valproic acid (VPA) is one of the most commonly used first generation anti-seizure medications (ASMs). In the last two decades, use of next generation ASMs, mainly Levetiracetam (LVT), Lamotrigine (LTG), and Topiramate (TPM) has also increased.
Objective
To compare the response rate, tolerability and efficacy of VPA with next generation ASMs (LVT, LTG and TPM)
Method:
As part of the development of an epilepsy database, we retrospectively reviewed the electronic medical records of patients with the diagnosis of epilepsy. Patients on monotherapy of VPA, LVT, LTG, and TPM were identified. ILAE classification for seizures (2017) was utilized and p-value < 0.05 was considered as statistically significant. Seizure-free state was defined as no reported seizures based on three times the longest pre-intervention the interval of seizures.
Results:
Out of 1665 patients, 93 (5.58%) patients were on VPA monotherapy compared to 291 (17.47%) patients on LVT, 189 (11.35%) patients on LTG, and 64 (3.84%) patients on TPM. Mean age of patients among all group was highest in LVT (52.28 ± 19.7), compared to VPA (44.94 ± 16.96), LTG (47.61 ± 18.31) and TPM (45.91 ± 16.75). VPA was used more commonly in patients with seizure onset at younger age (28.40 ± 20.35) compared to second generation ASMs (LVT: 42.68 ± 23.10, LTG: 35.7 ±20.24, TPM: 31.55 ± 17.8). Mean duration of epilepsy was similar in VPA and TPM (12.97 ± 12.9) compared to LVT (9.44 ± 9.91) and LTG (11.7 ± 9.9). VPA was used more commonly in men compared to women (69.1% vs 30.1%), as opposed to LTG (34.39% vs 64.60%) and TPM (34.4% vs 65.6%) which were used most commonly in women. Proportion of focal epilepsy and generalized epilepsy patients were the same in all groups. VPA was first prescribed drug in 78.5% as compared to LVT in 86.94%, TPM in 79.8%, LTG in 74.06% and VPA was switched from other agents in 20.2%, compared to LTG in 25.39%, TPM 19.2%, LVT in 13.05%. Discontinuation rates with initial monotherapy with VPA was 79/172 (45.93%), compared to TPM 55/119 (46.2%), LVT 96/387 (24.87%) and LTG 53/242 (21.9%), p< 0.05. Overall seizure-free rate with VPA was lower (18.02%), compared to LTG (29.3%) and LVT (20.9%), though higher than TPM (17.01%) p-NS.
Conclusion:
LVT and LTG are the most commonly used monotherapy agents in our population. VPA and TPM are more frequently utilized in younger patients, with higher initial discontinuation rates. VPA use was more common in men compared to women. LTG was associated with a highest rate of seizure freedom.
Funding:
:None
Clinical Epilepsy