Skip to main content
Top
Published in: Neurology and Therapy 2/2019

Open Access 01-12-2019 | Antiepileptic Drugs | Original Research

Effectiveness and Safety/Tolerability of Eslicarbazepine Acetate in Epilepsy Patients Aged ≥ 60 Versus < 60 Years: A Subanalysis from the Euro-Esli Study

Authors: Charlotte Lawthom, Pedro Bermejo, Dulce Campos, Rob McMurray, Vicente Villanueva

Published in: Neurology and Therapy | Issue 2/2019

Login to get access

Abstract

Introduction

Clinical practice studies help guide antiepileptic drug (AED) therapy in patient groups routinely excluded from clinical trials, such as the elderly. The Euro-Esli study investigated the effectiveness and safety/tolerability of eslicarbazepine acetate (ESL) when used in everyday clinical practice in Europe. A subanalysis of data from elderly patients (≥ 60 years) included in the Euro-Esli study was conducted to assess these aspects of ESL use in this population.

Methods

Euro-Esli was a pooled analysis of 14 European clinical practice studies. Effectiveness parameters included responder (≥ 50% seizure frequency reduction) and seizure freedom rates after 3, 6 and 12 months of treatment and at last visit. Safety and tolerability were assessed throughout the follow-up by evaluating adverse events (AEs) and ESL discontinuation due to AEs, respectively. Data were compared for patients aged ≥ 60 versus those aged < 60 years at study entry.

Results

Euro-Esli included 2058 patients (mean age 44.0 years). Age at study entry was known for 2057 patients, of whom 358 (17.4%) and 1699 (82.6%) were aged ≥ 60 and < 60 years, respectively. Mean maximum ESL dose was   882.0 and 1008.2 mg/day in patients aged ≥ 60 and < 60 years, respectively  (p < 0.001). At all timepoints, responder and seizure freedom rates were significantly higher in patients aged ≥ 60 versus < 60 years; for example, at 12 months, responder rates were 83.9 and 73.7%, respectively (p = 0.002), and seizure freedom rates were 58.5 and 37.1%, respectively (p < 0.001). The incidence of AEs was significantly higher in patients aged ≥ 60 versus < 60 years (41.4 vs. 32.5%; p = 0.001), but the rate of discontinuation due to AEs was comparable between age groups (16.2 vs 13.1%; p = not significant). The safety/tolerability of ESL in patients aged ≥ 60 years was consistent with its known    profile.

Conclusion

Eslicarbazepine acetate was efficacious and generally well tolerated when used to treat elderly patients with focal epilepsy in clinical practice, with no new or unexpected safety signals emerging in this setting.

Funding

Eisai Ltd.
Literature
3.
go back to reference Sen A, Sander JW. Epilepsy and seizures in geriatric practice. In: Rugg-Gunn FJ, Stapley HB, eds. Epilepsy 2017. From Bench to Bedside. A Practical Guide to Epilepsy. Crawley: International League Against Epilepsy (British Chapter); 2017:469–75 Sen A, Sander JW. Epilepsy and seizures in geriatric practice. In: Rugg-Gunn FJ, Stapley HB, eds. Epilepsy 2017. From Bench to Bedside. A Practical Guide to Epilepsy. Crawley: International League Against Epilepsy (British Chapter); 2017:469–75
4.
go back to reference Ferlazzo E, Sueri C, Gasparini S, Aguglia U. Challenges in the pharmacological management of epilepsy and its causes in the elderly. Pharmacol Res. 2016;106:21–6.CrossRefPubMed Ferlazzo E, Sueri C, Gasparini S, Aguglia U. Challenges in the pharmacological management of epilepsy and its causes in the elderly. Pharmacol Res. 2016;106:21–6.CrossRefPubMed
5.
go back to reference Fisher RS, Cross JH, French JA, et al. Operational classification of seizure types by the International League against epilepsy: position paper of the ILAE commission for classification and terminology. Epilepsia. 2017;58:522–30.CrossRefPubMed Fisher RS, Cross JH, French JA, et al. Operational classification of seizure types by the International League against epilepsy: position paper of the ILAE commission for classification and terminology. Epilepsia. 2017;58:522–30.CrossRefPubMed
6.
go back to reference Tanaka E. In vivo age-related changes in hepatic drug-oxidizing capacity in humans. J Clin Pharm Ther. 1998;23:247–55.CrossRefPubMed Tanaka E. In vivo age-related changes in hepatic drug-oxidizing capacity in humans. J Clin Pharm Ther. 1998;23:247–55.CrossRefPubMed
14.
go back to reference Costa R, Steinhoff B, Gama H, Ikedo F, Rocha JF, Soares-da-Silva P. Safety, tolerability and efficacy of eslicarbazepine acetate as adjunctive therapy in patients aged ≥ 65 years with focal seizures. Drugs Aging. 2018;35:1109–17.CrossRefPubMedPubMedCentral Costa R, Steinhoff B, Gama H, Ikedo F, Rocha JF, Soares-da-Silva P. Safety, tolerability and efficacy of eslicarbazepine acetate as adjunctive therapy in patients aged ≥ 65 years with focal seizures. Drugs Aging. 2018;35:1109–17.CrossRefPubMedPubMedCentral
15.
go back to reference Villanueva V, Holtkamp M, Delanty N, Rodriguez-Uranga J, McMurray R, Santagueda P. Euro-Esli: a European audit of real-world use of eslicarbazepine acetate as a treatment for partial-onset seizures. J Neurol. 2017;264:2232–48.CrossRefPubMedPubMedCentral Villanueva V, Holtkamp M, Delanty N, Rodriguez-Uranga J, McMurray R, Santagueda P. Euro-Esli: a European audit of real-world use of eslicarbazepine acetate as a treatment for partial-onset seizures. J Neurol. 2017;264:2232–48.CrossRefPubMedPubMedCentral
16.
go back to reference The International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH). Medical Dictionary for Regulatory Activities (MedDRA). 2013. http://www.meddra.org/. Accessed 16 Apr 2019. The International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH). Medical Dictionary for Regulatory Activities (MedDRA). 2013. http://​www.​meddra.​org/​. Accessed 16 Apr 2019.
17.
go back to reference Stephen LJ, Kelly K, Mohanraj R, Brodie MJ. Pharmacological outcomes in older people with newly diagnosed epilepsy. Epilepsy Behav. 2006;8:434–7.CrossRefPubMed Stephen LJ, Kelly K, Mohanraj R, Brodie MJ. Pharmacological outcomes in older people with newly diagnosed epilepsy. Epilepsy Behav. 2006;8:434–7.CrossRefPubMed
18.
go back to reference Brodie MJ, Stephen LJ. Outcomes in elderly patients with newly diagnosed and treated epilepsy. Int Rev Neurobiol. 2007;81:253–63.CrossRefPubMed Brodie MJ, Stephen LJ. Outcomes in elderly patients with newly diagnosed and treated epilepsy. Int Rev Neurobiol. 2007;81:253–63.CrossRefPubMed
19.
go back to reference Gómez-Ibáñez A, Serratosa JM, Guillamón E, et al. Efficacy and safety of eslicarbazepine-acetate in elderly patients with focal epilepsy: case series. Seizure. 2017;48:53–6.CrossRefPubMed Gómez-Ibáñez A, Serratosa JM, Guillamón E, et al. Efficacy and safety of eslicarbazepine-acetate in elderly patients with focal epilepsy: case series. Seizure. 2017;48:53–6.CrossRefPubMed
20.
go back to reference Werhahn KJ, Trinka E, Dobesberger J, et al. A randomized, double-blind comparison of antiepileptic drug treatment in the elderly with new-onset focal epilepsy. Epilepsia. 2015;56:450–9.CrossRefPubMed Werhahn KJ, Trinka E, Dobesberger J, et al. A randomized, double-blind comparison of antiepileptic drug treatment in the elderly with new-onset focal epilepsy. Epilepsia. 2015;56:450–9.CrossRefPubMed
21.
go back to reference Brodie MJ, Overstall PW, Giorgi L. Multicentre, double-blind, randomised comparison between lamotrigine and carbamazepine in elderly patients with newly diagnosed epilepsy. The UK Lamotrigine Elderly Study Group. Epilepsy Res. 1999;37:81–7.CrossRefPubMed Brodie MJ, Overstall PW, Giorgi L. Multicentre, double-blind, randomised comparison between lamotrigine and carbamazepine in elderly patients with newly diagnosed epilepsy. The UK Lamotrigine Elderly Study Group. Epilepsy Res. 1999;37:81–7.CrossRefPubMed
22.
go back to reference Rowan AJ, Ramsay RE, Collins JF, VA Cooperative Study 428 Group, et al. New onset geriatric epilepsy: a randomized study of gabapentin, lamotrigine, and carbamazepine. Neurology. 2005;64:1868–73.CrossRefPubMed Rowan AJ, Ramsay RE, Collins JF, VA Cooperative Study 428 Group, et al. New onset geriatric epilepsy: a randomized study of gabapentin, lamotrigine, and carbamazepine. Neurology. 2005;64:1868–73.CrossRefPubMed
23.
go back to reference Saetre E, Perucca E, Isojärvi J, Gjerstad L, LAM 40089 Study Group. An international multicenter randomized double-blind controlled trial of lamotrigine and sustained-release carbamazepine in the treatment of newly diagnosed epilepsy in the elderly. Epilepsia. 2007;48:1292–302.CrossRefPubMed Saetre E, Perucca E, Isojärvi J, Gjerstad L, LAM 40089 Study Group. An international multicenter randomized double-blind controlled trial of lamotrigine and sustained-release carbamazepine in the treatment of newly diagnosed epilepsy in the elderly. Epilepsia. 2007;48:1292–302.CrossRefPubMed
24.
go back to reference Ramsay RE, Uthman B, Pryor FM, et al. Topiramate in older patients with partial-onset seizures: a pilot double-blind, dose-comparison study. Epilepsia. 2008;49:1180–5.CrossRefPubMed Ramsay RE, Uthman B, Pryor FM, et al. Topiramate in older patients with partial-onset seizures: a pilot double-blind, dose-comparison study. Epilepsia. 2008;49:1180–5.CrossRefPubMed
25.
go back to reference Cumbo E, Ligori LD. Levetiracetam, lamotrigine, and phenobarbital in patients with epileptic seizures and Alzheimer’s disease. Epilepsy Behav. 2010;17:461–6.CrossRefPubMed Cumbo E, Ligori LD. Levetiracetam, lamotrigine, and phenobarbital in patients with epileptic seizures and Alzheimer’s disease. Epilepsy Behav. 2010;17:461–6.CrossRefPubMed
26.
go back to reference Villanueva V, Giráldez BG, Toledo M, et al. Lacosamide monotherapy in clinical practice: a retrospective chart review. Acta Neurol Scand. 2018;138:186–94.CrossRefPubMedPubMedCentral Villanueva V, Giráldez BG, Toledo M, et al. Lacosamide monotherapy in clinical practice: a retrospective chart review. Acta Neurol Scand. 2018;138:186–94.CrossRefPubMedPubMedCentral
27.
go back to reference Trinka E, Steinhoff BJ, Nikanorova M, Brodie MJ. Perampanel for focal epilepsy: insights from early clinical experience. Acta Neurol Scand. 2016;133:160–72.CrossRefPubMed Trinka E, Steinhoff BJ, Nikanorova M, Brodie MJ. Perampanel for focal epilepsy: insights from early clinical experience. Acta Neurol Scand. 2016;133:160–72.CrossRefPubMed
28.
go back to reference Belcastro V, Costa C, Galletti F, et al. Levetiracetam in newly diagnosed late-onset post-stroke seizures: a prospective observational study. Epilepsy Res. 2008;82:223–6.CrossRefPubMed Belcastro V, Costa C, Galletti F, et al. Levetiracetam in newly diagnosed late-onset post-stroke seizures: a prospective observational study. Epilepsy Res. 2008;82:223–6.CrossRefPubMed
29.
go back to reference Bernus I, Dickinson RG, Hooper WD, Eadie MJ. Anticonvulsant therapy in aged patients. Clinical pharmacokinetic considerations. Drugs Aging. 1997;10:278–89.CrossRefPubMed Bernus I, Dickinson RG, Hooper WD, Eadie MJ. Anticonvulsant therapy in aged patients. Clinical pharmacokinetic considerations. Drugs Aging. 1997;10:278–89.CrossRefPubMed
30.
go back to reference Willmore LJ. Choice and use of newer anticonvulsant drugs in older patients. Drugs Aging. 2000;17:441–52.CrossRefPubMed Willmore LJ. Choice and use of newer anticonvulsant drugs in older patients. Drugs Aging. 2000;17:441–52.CrossRefPubMed
31.
go back to reference van Dijkman SC, Rauwé WM, Danhof M, Della Pasqua O. Pharmacokinetic interactions and dosing rationale for antiepileptic drugs in adults and children. Br J Clin Pharmacol. 2018;84:97–111.CrossRefPubMed van Dijkman SC, Rauwé WM, Danhof M, Della Pasqua O. Pharmacokinetic interactions and dosing rationale for antiepileptic drugs in adults and children. Br J Clin Pharmacol. 2018;84:97–111.CrossRefPubMed
34.
go back to reference Villanueva V, Serratosa JM, Guillamón E, et al. Long-term safety and efficacy of eslicarbazepine acetate in patients with focal seizures: results of the 1-year ESLIBASE retrospective study. Epilepsy Res. 2014;108:1243–52.CrossRefPubMed Villanueva V, Serratosa JM, Guillamón E, et al. Long-term safety and efficacy of eslicarbazepine acetate in patients with focal seizures: results of the 1-year ESLIBASE retrospective study. Epilepsy Res. 2014;108:1243–52.CrossRefPubMed
35.
go back to reference Massot A, Vivanco R, Principe A, Roquer J, Rocamora R. Post-authorisation study of eslicarbazepine as treatment for drug-resistant epilepsy: preliminary results. Neurologia. 2014;29:94–101.CrossRefPubMed Massot A, Vivanco R, Principe A, Roquer J, Rocamora R. Post-authorisation study of eslicarbazepine as treatment for drug-resistant epilepsy: preliminary results. Neurologia. 2014;29:94–101.CrossRefPubMed
36.
go back to reference Shorvon SD, Trinka E, Steinhoff BJ, et al. Eslicarbazepine acetate: its effectiveness as adjunctive therapy in clinical trials and open studies. J Neurol. 2017;264:421–31.CrossRefPubMedPubMedCentral Shorvon SD, Trinka E, Steinhoff BJ, et al. Eslicarbazepine acetate: its effectiveness as adjunctive therapy in clinical trials and open studies. J Neurol. 2017;264:421–31.CrossRefPubMedPubMedCentral
Metadata
Title
Effectiveness and Safety/Tolerability of Eslicarbazepine Acetate in Epilepsy Patients Aged ≥ 60 Versus < 60 Years: A Subanalysis from the Euro-Esli Study
Authors
Charlotte Lawthom
Pedro Bermejo
Dulce Campos
Rob McMurray
Vicente Villanueva
Publication date
01-12-2019
Publisher
Springer Healthcare
Published in
Neurology and Therapy / Issue 2/2019
Print ISSN: 2193-8253
Electronic ISSN: 2193-6536
DOI
https://doi.org/10.1007/s40120-019-0137-0

Other articles of this Issue 2/2019

Neurology and Therapy 2/2019 Go to the issue