Elderly patients taking levetiracetam (LEV) may exhibit longer time to treatment withdrawal than those treated with standard anti-epileptic drugs (AEDs), according to a study published in BMC Neurology.
Health care professionals have long recognized rising incidence of new-onset epilepsy in the elderly population, but have continued to struggle with selecting optimal treatments that balance efficacy and toxicity.
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To better understand the characteristics of difference epilepsy treatments, researchers led by Bernd Pullman-Eden, Dalhousie University (Nova Scotia, Canada), conducted a post-hoc subgroup analysis of patients 60 years and older with newly diagnosed epilepsy to compare the effectiveness of LEV with extended-release sodium valproate (VPA-ER) or controlled-release carbamazepine (CBZ-CR), common AEDs.
Data for the study was taken from the KOMET, phase IV trial, which compared the effectiveness of LEV, VPA-ER and CBZ-CR among a large group of patients aged 16 years and older with newly diagnosed epilepsy. The trial was not blinded and treatment choice was based on investigators’ judgment, which in clinical practice is based mainly on clarity of diagnosis, seizure type, and patient characteristics.
Of 1698 total patients included in the trial, 308 were age 60 years or older and included in the analysis. After standard care, 152 patients received LEV, 53 patients were treated with VPA-ER, and 103 patients received CBZ-CR.
Statistical analyses revealed that, compared with standard AEDs, time to treatment withdrawal was significantly longer in those receiving LEV (HR 0.44, 95 % CI 0.28–0.67). Further, while this difference was prominent among older adults, when the model was expanded to include the entire trial population, there was no observed difference in time to treatment withdrawal between LEV and standard AEDs, indicating that treatment effect differs with age.
However, higher incidences of severe adverse events were reported among patients in the LEV group (20.5%) compared with those who were treated with CBZ-CR (17.5%) or VPA-ER (8.2%); yet, more patients treated with standard AEDs discontinued treatment due to adverse events than those in the LEV group.
“As a pragmatic trial, KOMET had a number of limitations, including patient selection and treatment allocation at the discretion of the physician, and unblinded treatment,” authors said regarding the limitations of their study. “Another major limitation is the lack of neuroimaging information with regard to underlying etiology, which likely has a major prognostic impact in this specific epilepsy population.”
Still, they concluded that LEV had a longer time to treatment withdrawal than those treated with standard AEDs. Therefore, LEV should be considered as a suitable treatment option for patients 60 years and older with newly diagnosed epilepsy.
