First-line levetiracetam versus enzyme-inducing antiseizure medication in glioma patients with epilepsy.
antiepileptic drug
brain tumor
glioma
levetiracetam
retention rates
seizure
treatment failure
Journal
Epilepsia
ISSN: 1528-1167
Titre abrégé: Epilepsia
Pays: United States
ID NLM: 2983306R
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
revised:
08
11
2022
received:
22
09
2022
accepted:
14
11
2022
pubmed:
17
11
2022
medline:
21
1
2023
entrez:
16
11
2022
Statut:
ppublish
Résumé
This study aimed to directly compare the effectiveness of first-line monotherapy levetiracetam (LEV) versus enzyme-inducing antiseizure medications (EIASMs) in glioma patients. In this nationwide retrospective observational cohort study, Grade 2-4 glioma patients were included, with a maximum duration of follow-up of 36 months. Primary outcome was antiseizure medication (ASM) treatment failure for any reason, and secondary outcomes were treatment failure due to uncontrolled seizures and due to adverse effects. For estimation of the association between ASM treatment and ASM treatment failure, multivariate cause-specific cox proportional hazard models were estimated, adjusting for potential confounders. In the original cohort, a total of 808 brain tumor patients with epilepsy were included, of whom 109 glioma patients were prescribed first-line LEV and 183 glioma patients first-line EIASMs. The EIASM group had a significantly higher risk of treatment failure for any reason compared to LEV (adjusted hazard ratio [aHR] = 1.82, 95% confidence interval [CI] = 1.20-2.75, p = .005). Treatment failure due to uncontrolled seizures did not differ significantly between EIASMs and LEV (aHR = 1.32, 95% CI = .78-2.25, p = .300), but treatment failure due to adverse effects differed significantly (aHR = 4.87, 95% CI = 1.89-12.55, p = .001). In this study, it was demonstrated that LEV had a significantly better effectiveness (i.e., less ASM treatment failure for any reason or due to adverse effects) compared to EIASMs, supporting the current neuro-oncology guideline recommendations to avoid EIASMs in glioma patients.
Identifiants
pubmed: 36380710
doi: 10.1111/epi.17464
pmc: PMC10100008
doi:
Substances chimiques
Levetiracetam
44YRR34555
Anticonvulsants
0
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
162-169Informations de copyright
© 2022 The Authors. Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.
Références
Neuro Oncol. 2021 Nov 2;23(11):1835-1844
pubmed: 34174071
CNS Drugs. 2021 Sep;35(9):935-963
pubmed: 34145528
Eur J Neurol. 2007 Dec;14(12):1317-21
pubmed: 17903210
Neurooncol Pract. 2016 Dec;3(4):245-260
pubmed: 31385988
Epilepsia. 1998 Jul;39(7):799-803
pubmed: 9670910
Ther Adv Drug Saf. 2011 Aug;2(4):141-58
pubmed: 25083209
Seizure. 2011 Jun;20(5):369-75
pubmed: 21306922
Epilepsia. 2013 Mar;54(3):551-63
pubmed: 23350722
Lancet Oncol. 2014 Aug;15(9):e395-403
pubmed: 25079102
Lancet. 2021 Apr 10;397(10282):1363-1374
pubmed: 33838757
Epilepsia. 2021 May;62(5):1119-1129
pubmed: 33735464
Clin Pharmacol Ther. 1981 Aug;30(2):239-45
pubmed: 7249508
Neurology. 2022 Sep 06;99(10):e999-e1008
pubmed: 36219797
J Neurooncol. 2021 May;153(1):89-98
pubmed: 33822293
Neurology. 2000 May 23;54(10):1886-93
pubmed: 10822423
Lancet Oncol. 2012 Sep;13(9):e375-82
pubmed: 22935237
Neuro Oncol. 2014 Apr;16(4):584-8
pubmed: 24311644
J Neurooncol. 2009 Jul;93(3):349-54
pubmed: 19169651
PLoS One. 2017 Jul 17;12(7):e0180470
pubmed: 28715490
Nat Rev Clin Oncol. 2021 Mar;18(3):170-186
pubmed: 33293629
Neurooncol Pract. 2021 Oct 21;9(2):105-113
pubmed: 35371521
Epilepsia. 2023 Jan;64(1):162-169
pubmed: 36380710
Eur J Clin Pharmacol. 2007 Apr;63(4):409-15
pubmed: 17347806
Neurol Sci. 2019 Oct;40(10):2217-2234
pubmed: 31392641
Neurooncol Pract. 2021 May 28;8(5):501-517
pubmed: 34589231
JAMA Neurol. 2020 May 1;77(5):574-581
pubmed: 32091535
Neuro Oncol. 2016 Jun;18(6):779-89
pubmed: 26527735
Epilepsia. 2012 Dec;53 Suppl 8:26-39
pubmed: 23205960