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A Pharmacoepidemiologic Study of Factors Influencing the Outcome of Treatment with Lamotrigine in Chronic Epilepsy
Author(s) -
Wong Ian C. K.,
Mawer George E.,
Sander Josemir W. A. S.,
Lhatoo Samden D.
Publication year - 2001
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1046/j.1528-1157.2001.02101.x
Subject(s) - lamotrigine , epilepsy , carbamazepine , medicine , vigabatrin , anticonvulsant , retrospective cohort study , gabapentin , generalized epilepsy , logistic regression , anesthesia , valproic acid , pediatrics , psychiatry , alternative medicine , pathology
Summary: Purpose: To identify prognostic factors for freedom from seizures and long‐term retention of treatment in patients receiving lamotrigine (LTG). Methods: A multicenter, retrospective, case record study of 1,050 patients with chronic epilepsy was carried out. Logistic regression and Cox regression analyses were used to identify clinical features associated with freedom from seizures and retention of treatment, respectively. Long‐term retention rates of LTG therapy were estimated using Kaplan–Meier survival analysis. Results: The 1,050 patients with chronic epilepsy were included in the study. Patients with generalized epilepsy (p = 0.01), who were not receiving carbamazepine (CBZ; p = 0.02) were more likely to become seizure‐free. Sixty percent of patients continued on LTG therapy >1 year and estimated retention at 8 years was 38%. Patients with generalized epilepsy (p = 0.002), patients receiving concurrent sodium valproate (VPA; p < 0.0001), those not previously exposed to gabapentin and vigabatrin (p < 0.0001), and those in whom the starting dose was lower (p < 0.0012), were more likely to remain on long‐term treatment with LTG. The relationships with exposure to other antiepileptic drugs remained significant in patients with focal and with generalized epilepsy when considered separately. Conclusions: The best results from LTG treatment in terms of freedom from seizures and long‐term retention of treatment were obtained in patients with generalized epilepsy. Retention of treatment was enhanced by VPA not only in generalized but also in focal epilepsy. The importance of a low starting dose of LTG was again confirmed. The apparent negative effect of CBZ in patients taking LTG merits further investigation.