Carbamazepine, lamotrigine, valproate: comparing risks of adverse cardiovascular events

Excerpt

Carbamazepine and valproate use is associated with a higher risk of incident adverse cardiovascular events (CEs) compared to lamotrigine, according to a study from the UK.The retrospective cohort study compared incident CEs in adult people with epilepsy (PWE) taking carbamazepine, lamotrigine or sodium valproate during the period between January 2000 and January 2015. The study used electronic health data from TriNetX, et al. global health federated network that contains electronic patient records from > 120 healthcare organisations across 19 countries.The analysis included data from 374 950 adult PWE, which were divided into three cohorts after propensity-score matching (carbamazepine versus lamotrigine [n = 4722], valproate versus lamotrigine [n = 5478] and valproate versus carbamazepine [n = 4544]). Lamotrigine use was associated with fewer incident CEs compared to carbamazepine or valproate. Carbamazepine and valproate had comparable cardiovascular risks. Compared to lamotrigine, carbamazepine was associated with significantly higher risk of composite adverse CEs, with hazard ratios (HRs) of 1.351 (95% 1.086−1.682) and 1.390 (95% CI 1.160−1.665) for up to 5 and 10 years of follow-up, respectively. Similarly, valproate was associated with higher risk of composite adverse cardiovascular outcome, compared to lamotrigine, with HRs of 1.271 (95% CI 1.018−1.586) and 1.264 (95% CI 1.050−1.521), respectively. The analysis also showed that carbamazepine was associated with higher risk of hyperlipidaemia compared to lamotrigine and compared to valproate at 10 years of follow-up (HR 1.324 [95% CI 1.174−1.492] and 0.880 [95% CI 0.781−0.991], respectively). Valproate was associated with higher risk of all-cause death compared to carbamazepine or lamotrigine. …