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Comparative effectiveness of eight antiepileptic drugs in adults with focal refractory epilepsy: the influence of age, gender, and the sequence in which drugs were introduced onto the market

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Abstract

The first objective was to determine the long-term retention rate of eight antiepileptic drugs (AEDs) commonly used as adjunctive therapy in adults with focal refractory epilepsy. Second, we assessed the effects of age and gender on retention rates. Third, we examined if the retention rate could be influenced by the sequence in which the AEDs had entered the market. Patients with focal refractory epilepsy treated with any of the eight AEDs in Tampere University Hospital were identified retrospectively (N = 507). Retention rates were evaluated with the Kaplan–Meier method. Follow-up started at the first date of treatment and each individual was followed a maximum of 36 months. We calculated the following 3-year retention rates: lacosamide 77.1% (N = 137), lamotrigine 68.3% (N = 177), levetiracetam 66.7% (N = 319), clobazam 65.6% (N = 130), topiramate 61.6% (N = 178), zonisamide 60.4% (N = 103), pregabalin 54.6% (N = 127), and gabapentin 40.2% (N = 66). Lacosamide, levetiracetam, and clobazam were the most effective AEDs in the elderly. The retention rate for pregabalin was higher in males (65%) than females (51%) whereas females had higher retention rates for both topiramate (72 vs. 58%) and zonisamide (67 vs. 57%). The retention rate was influenced by the sequence in which these AEDs entered the market. We provide important information about practical aspects of these eight AEDs, revealing that there are differences in their effectiveness as adjunctive treatment for focal refractory epilepsy. Most importantly, the retention rate appears to be influenced by the sequence in which these AEDs were introduced onto the market.

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Acknowledgements

All authors meet the International Committee of Medical Journals Editors (ICMJE) criteria for authorship and have given final approval to the manuscript to be published.

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Authors and Affiliations

  1. Department of Neurology, Tampere University Hospital, PO BOX 2000, 33521, Tampere, Finland

    Jussi Mäkinen, Tiina Alapirtti & Sirpa Rainesalo

  2. Department of Neurology, University of Tampere and Tampere University Hospital, PO BOX 2000, 33521, Tampere, Finland

    Jukka Peltola

  3. Faculty of Social Sciences, University of Tampere, Tampere, Finland

    Jani Raitanen

  4. UKK Institute for Health Promotion, Tampere, Finland

    Jani Raitanen

Authors
  1. Jussi Mäkinen
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  2. Jukka Peltola
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  5. Sirpa Rainesalo
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Corresponding author

Correspondence to Jussi Mäkinen.

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Ethical standards

This was a non-invasive, retrospective study, which does not oblige ethics committee approval according to Finnish Law on Research. Access to patient records based on decision made by Head of Science Centre, Tampere University Hospital research and innovation services, Science Center.

Conflicts of interest and sources of funding statement

Jussi Mäkinen has received support for travel congresses from Biogen-Idec, Boehringer-Ingelheim, Eisai, and Orion Pharma; received speaker honoraria from Boehringer-Ingelheim; received research funding from the Finnish Epilepsy Association and Maire Taponen Foundation; and participated in an advisory board for Eisai. Jani Raitanen has no conflict of interest. Sirpa Rainesalo has received speaker honoraria from FennoMedical, Orion Pharma, UCB and received support for travel to congresses from Abbvie and UCB. Tiina Alapirtti has received support for travel to congresses from Biogen, AbbVie, Biogen, Genzyme, Roche, and UCB. Jukka Peltola has participated in clinical trials for Eisai, UCB, and Bial; received research grants from Eisai, Medtronic, UCB, and Cyberonics; received speaker honoraria from Cyberonics, Eisai, Medtronic, Orion Pharma, and UCB; received support for travel congresses from Cyberonics, Eisai, Medtronic, and UCB; and participated in advisory boards for Cyberonics, Eisai, Medtronic, UCB, and Pfizer.

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Mäkinen, J., Peltola, J., Raitanen, J. et al. Comparative effectiveness of eight antiepileptic drugs in adults with focal refractory epilepsy: the influence of age, gender, and the sequence in which drugs were introduced onto the market. J Neurol 264, 1345–1353 (2017). https://doi.org/10.1007/s00415-017-8526-8

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  • DOI: https://doi.org/10.1007/s00415-017-8526-8

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