Results published in the June online edition of Seizure from an independent multicentre study covering 19 epilepsy clinics in the UK showed that oral lacosamide administered as adjunctive therapy in refractory epilepsy is an effective and generally well-tolerated treatment, achieving seizure freedom for some patients.
“This is the largest independently reviewed and published cohort of patients on lacosamide”, said Dr Robert Elwes, Consultant Neurologist and Neurophysiologist, Department of Clinical Neurosciences, King’s College Hospital NHS Foundation Trust.
Dr Elwes continued, “The results reflect real world experience with lacosamide and it is welcomed news that the outcomes are generally similar to those in the published randomized trials.”
The study included 403 adult patients with refractory epilepsy across 19 sites in the UK, in whom lacosamide had been prescribed as adjunctive therapy to a range of concomitant anti-epileptic drugs (AEDs).
Mean follow-up (FU) of patients was 11.6 months with the duration on lacosamide ranging from one day to 42 months.
Ninety two percent (372/403) of patients presented with partial epilepsy and 79% (320/403) were taking two or more AEDs when lacosamide was added (mean=2.29, range 0-4).
The initial daily dose of lacosamide varied from 25 mg and 200 mg with 50 mg daily being the most frequent dose, and the mean maximum daily dose was 280mg.
The efficacy of lacosamide was evaluated at two time points: within three months of starting lacosamide (n=347), and within the last three months (n=285) of FU.
Results from the study indicated the following:
• Within the first three months 31.1% of patients (108/347) reported ≥50% seizure reduction and 9.2% (32/347) were seizure free
• At final FU 37.5% of patients (102/285) reported ≥50% seizure reduction and 9.8% (28/285) were seizure free
• The probability of remaining on lacosamide was calculated as 80% at six months, 68% at one year and 45% at two years
Adverse events (AEs) were reported in 48.7% of patients (193/403) with the most frequent being sedation, dizziness and nausea. 20.8% of patients (84/403) withdrew from the study due to intolerable AEs.
The key findings from this study of refractory patients in the everyday clinical setting are complementary to the pivotal trials data from a broadly similar population.