Outcomes with Cenobamate Use for Drug Resistant Epilepsy in Clinical Practice
Abstract number :
3.301
Submission category :
7. Anti-seizure Medications / 7C. Cohort Studies
Year :
2022
Submission ID :
2205066
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:27 AM
Authors :
Shubhi Agrawal, MD – University of California Davis; kathleen Fulton, PA – Sinai Hospital; Numthip Chitravas, MD – Sinai Hospital; Arash Foroughi, MD – Sinai Hospital; Lorraine Newborn-Palmer, MD – Sinai Hospital; perry Foreman, MD – Sinai Hospital
Rationale: Despite the introduction of multiple antiseizure medications over the last 20 years, about 30% epilepsy patients remain refractory to medical treatment alone. Cenobamate was approved in US in May 2020 and in the pivotal trials reported seizure freedom rates of up to 21%. The main objective of this study is to assess efficacy and tolerability of Cenobamate in patients with drug resistant epilepsy in community clinical practice.
Methods: This is a retrospective study looking at all patients who were initiated on Cenobamate at a single community hospital-based Level 4 Epilepsy Center. We looked at seizure freedom rate, responder rates, retention rate, and adverse events. All patients had at least 3-month follow up after completing titration.
Results: Between June 2020 and March 2022, 33 patients were initiated on Cenobamate at our center, ranging from 19-75 years of age. Most patients had drug resistant focal epilepsy except 2 patients with genetic epilepsy syndromes, 2 patients with Lennox-Gastaut syndrome, and 1 patient with drug resistant generalized epilepsy. Of the 33 patients initiated, 23 (69.7%) remain on the medication at doses ranging from 200 to 400 mg. 5 patients out of 33 (15.2%) attained seizure freedom, additional 5 patients (total of 30.3%) had > 90% reduction in seizure frequency and another 8 patients (total of 54.5%) had > 75% reduction in seizures. 66.7% patients had 50% or more reduction in seizures. Ten patients (30.3%) discontinued the medicine, 2 for lack of efficacy and the remainder for side effects. The two patients with Lennox-Gastaut syndrome showed had no benefit but the two patients with genetic epilepsies had 75%-90% reduction in seizures. Serious side effects included erythema multiforme in 1 patient and increased seizure clustering in another patient. Other notable side effects included dizziness, somnolence, lethargy, jitteriness, and weight gain. Dizziness and gait imbalance were most common in patients who were concomitantly on other sodium channel blocking anticonvulsants. One patient who discontinued the medicine due to paranoia, was seizure free on it. Two patients on concomitant Clobazam needed hospitalization due to somnolence and failure to thrive arising from very high Desmethylclobazam levels. One patient on concomitant warfarin had difficult to control INR during titration phase.
Conclusions: Our results support findings from clinical trials that Cenobamate shows good efficacy against drug resistant epilepsy. It is fairly well tolerated but has multiple drug interactions to consider carefully.
Funding: None
Anti-seizure Medications