Effectiveness of Antiseizure Medication Triple Therapy in Patients With Glioma With Refractory Epilepsy: An Observational Cohort Study.
Journal
Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060
Informations de publication
Date de publication:
04 04 2023
04 04 2023
Historique:
received:
08
07
2022
accepted:
07
12
2022
medline:
5
4
2023
pubmed:
9
2
2023
entrez:
8
2
2023
Statut:
ppublish
Résumé
Approximately 10% of patients with glioma with epilepsy need antiseizure medication (ASM) triple therapy due to refractory epilepsy. The aim of this study was to evaluate whether levetiracetam combined with valproic acid and clobazam (LEV + VPA + CLB), a frequently prescribed triple therapy, has favorable effectiveness compared with other triple therapy combinations in patients with glioma. This was a multicenter retrospective observational cohort study. The primary outcome was the cumulative incidence of time to treatment failure for any reason, from the start of ASM triple therapy treatment. The secondary outcomes included cumulative incidences of the following: (1) time to treatment failure due to uncontrolled seizures; (2) time to treatment failure due to adverse effects; and (3) time to recurrent seizures. Patients were followed up for a maximum duration of 36 months. Of 1,435 patients in the original cohort, 90 patients received ASM triple therapy after second-line ASM treatment failure due to uncontrolled seizures. LEV + VPA + CLB was prescribed to 48% (43/90) and other ASM triple therapy to 52% (47/90) of patients. The cumulative incidence of treatment failure for any reason of LEV + VPA + CLB did not statistically significantly differ from that of other ASM triple therapy combinations (12 months: 47% [95% CI 31%-62%] vs 42% [95% CI 27%-56%], LEV + VPA + CLB might show equivalent effectiveness compared with other ASM triple therapy combinations in patients with glioma. This study provides Class III evidence that for patients with glioma with refractory epilepsy on triple therapy ASMs, LEV + VPA + CLB demonstrated similar effectiveness and tolerability compared with other ASM triple therapy combinations.
Sections du résumé
BACKGROUND AND OBJECTIVES
Approximately 10% of patients with glioma with epilepsy need antiseizure medication (ASM) triple therapy due to refractory epilepsy. The aim of this study was to evaluate whether levetiracetam combined with valproic acid and clobazam (LEV + VPA + CLB), a frequently prescribed triple therapy, has favorable effectiveness compared with other triple therapy combinations in patients with glioma.
METHODS
This was a multicenter retrospective observational cohort study. The primary outcome was the cumulative incidence of time to treatment failure for any reason, from the start of ASM triple therapy treatment. The secondary outcomes included cumulative incidences of the following: (1) time to treatment failure due to uncontrolled seizures; (2) time to treatment failure due to adverse effects; and (3) time to recurrent seizures. Patients were followed up for a maximum duration of 36 months.
RESULTS
Of 1,435 patients in the original cohort, 90 patients received ASM triple therapy after second-line ASM treatment failure due to uncontrolled seizures. LEV + VPA + CLB was prescribed to 48% (43/90) and other ASM triple therapy to 52% (47/90) of patients. The cumulative incidence of treatment failure for any reason of LEV + VPA + CLB did not statistically significantly differ from that of other ASM triple therapy combinations (12 months: 47% [95% CI 31%-62%] vs 42% [95% CI 27%-56%],
DISCUSSION
LEV + VPA + CLB might show equivalent effectiveness compared with other ASM triple therapy combinations in patients with glioma.
CLASSIFICATION OF EVIDENCE
This study provides Class III evidence that for patients with glioma with refractory epilepsy on triple therapy ASMs, LEV + VPA + CLB demonstrated similar effectiveness and tolerability compared with other ASM triple therapy combinations.
Identifiants
pubmed: 36754633
pii: WNL.0000000000206852
doi: 10.1212/WNL.0000000000206852
pmc: PMC10104607
doi:
Substances chimiques
Anticonvulsants
0
Valproic Acid
614OI1Z5WI
Types de publication
Observational Study
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1488-e1496Informations de copyright
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.
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