OVERNIGHT SWITCH FROM CARBAMAZEPINE TO OXCARBAZEPINE MONOTHERAPY IS AS EFFECTIVE AND WELL TOLERATED AS MORE PROGRESSIVE SWITCH
Abstract number :
2.253
Submission category :
Year :
2003
Submission ID :
398
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Fiorenzo Albani, Agostino Baruzzi, Barbara Grassi, Renato Turrini Department of Neurological Sciences, University of Bologna, Bologna, Italy; Medical Department, Novartis Farma, Origgio (VA), Italy
Patients whose seizures are inadequately controlled with carbamazepine monotherapy can be successfully switched to oxcarbazepine monotherapy (Sachdeo R, et al. Neurology 2001; 57: 864-71).One retrospective analysis suggested an overnight switch from carbamazepine to oxcarbazepine could be performed without titration (Homberg V, et al. Nervenarzt 2001; 72: 918-23). This prospective study was conducted to compare immediate with progressive switch from carbamazepine monotherapy to oxcarbazepine monotherapy.
In this multicenter, open-label, randomized, parallel-group study, patients with partial seizures receiving carbamazepine monotherapy were switched to oxcarbazepine monotherapy due to insufficient seizure control or poor tolerability. Patients [ge]14 years of age were randomized to either an immediate ([ldquo]overnight[rdquo]) or a more progressive switch (over several days) from carbamazepine to oxcarbazepine monotherapy following a dose ratio of 1:1.5. Seizure frequency and tolerability were evaluated for 2 months.
A total of 288 patients were included in the study. Overall, 286 patients were evaluable: 140 and 146 patients in the overnight and progressive switch groups, respectively. The overnight and progressive mean switch duration was 1.4 days (range: 1.0-3.0 days) and 7.0 days (range: 2.0-16.0 days), respectively. Mean oxcarbazepine maintenance dose for the overnight and progressive switch groups were 1201.3 and 1155.5 mg/day, respectively. The final mean daily dose of carbamazepine before starting switch was 786.4 mg/day and 764.4 mg/day for the immediate and slow switch groups, respectively. The similarity between the overnight and progressive switch methods was demonstrated by a 0.4 (95% confidence interval: -0.98 to 1.79) difference in mean number of seizures per month post-switch. Furthermore, 90.0% and 92.5% patients experienced good tolerability during both the overnight and progressive switch, respectively (difference of 2.5; 95% CI: -4.1 to 9.0).
This study demonstrated that an overnight switch from carbamazepine to oxcarbazepine monotherapy is effective and well tolerated. This would be of interest for various patients including those patients who are inadequately controlled with or unable to tolerate carbamazepine. Furthermore, switching patients from carbamazepine to oxcarbazepine is easy to manage.
[Supported by: Novartis Pharma]