Purpose

Optimal treatment with antiepileptic drugs (AEDs) is an important part of care for brain tumor patients with epileptic seizures. Lamotrigine and lacosamide are both examples of frequently used non-enzyme inducing AEDs with limited to no drug-drug interactions, reducing the risk of unfavorable side effects. This study aimed to compare the effectiveness of lamotrigine versus lacosamide.

Methods

In this multicenter study we retrospectively analyzed data of patients with diffuse grade 2–4 glioma with epileptic seizures. All patients received either lamotrigine or lacosamide during the course of their disease after treatment failure of first-line monotherapy with levetiracetam or valproic acid. Primary outcome was the cumulative incidence of treatment failure, from initiation of lamotrigine or lacosamide, with death as competing event, for which a competing risk model was used. Secondary outcomes were uncontrolled seizures after AED initiation and level of toxicity.

Results

We included a total of 139 patients of whom 61 (44%) used lamotrigine and 78 (56%) used lacosamide. At 12 months, there was no statistically significant difference in the cumulative incidence of treatment failure for any reason between lamotrigine and lacosamide: 38% (95%CI 26–51%) versus 30% (95%CI 20–41%), respectively. The adjusted hazard ratio for treatment failure of lacosamide compared to lamotrigine was 0.84 (95%CI 0.46–1.56). The cumulative incidences of treatment failure due to uncontrolled seizures (18% versus 11%) and due to adverse events (17% versus 19%) did not differ significantly between lamotrigine and lacosamide.

Conclusion

Lamotrigine and lacosamide show similar effectiveness in diffuse glioma patients with epilepsy.

中文翻译：

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神经胶质瘤患者抗癫痫药物治疗的有效性：拉莫三嗪与拉考沙胺

目的

抗癫痫药物 (AED) 的最佳治疗是癫痫发作脑肿瘤患者护理的重要组成部分。拉莫三嗪和拉考沙胺都是常用的非酶诱导 AED 的例子，它们仅限于或没有药物相互作用，从而降低了不良副作用的风险。本研究旨在比较拉莫三嗪与拉考沙胺的疗效。

方法

在这项多中心研究中，我们回顾性分析了伴有癫痫发作的弥漫性 2-4 级胶质瘤患者的数据。在左乙拉西坦或丙戊酸的一线单一疗法治疗失败后，所有患者在病程期间接受拉莫三嗪或拉考沙胺治疗。主要结果是治疗失败的累积发生率，从开始使用拉莫三嗪或拉考沙胺开始，死亡作为竞争事件，为此使用了竞争风险模型。次要结局是 AED 启动后不受控制的癫痫发作和毒性水平。

结果

我们共纳入 139 名患者，其中 61 名（44%）使用拉莫三嗪，78 名（56%）使用拉考沙胺。在 12 个月时，拉莫三嗪和拉考沙胺之间因任何原因导致治疗失败的累积发生率没有统计学上的显着差异：分别为 38% (95%CI 26–51%) 和 30% (95%CI 20–41%) . 与拉莫三嗪相比，拉考沙胺治疗失败的调整风险比为 0.84（95%CI 0.46–1.56）。由于不受控制的癫痫发作（18% 对 11%）和不良事件（17% 对 19%）导致治疗失败的累积发生率在拉莫三嗪和拉考沙胺之间没有显着差异。

结论

拉莫三嗪和拉考沙胺在弥漫性神经胶质瘤伴癫痫患者中显示出相似的疗效。