Adherence to and persistence with lacosamide, perampanel, lamotrigine, and levetiracetam in adult patients with focal epilepsy in Japan: A descriptive cohort study using a claims database

Comparative effectiveness, persistence, and adherence of dimethyl fumarate and fingolimod in patients with multiple sclerosis in Japan: A cohort study

BACKGROUND

Several oral disease-modifying drugs (DMDs) for multiple sclerosis (MS) are available but only two - dimethyl fumarate (DMF) and fingolimod (FTY) - are approved for relapsing-remitting MS in Japan. Although the efficacy of DMDs might be affected by differences in genetic and environmental factors, no study has compared the effectiveness, treatment persistence, and adherence of DMF and FTY in Asians. Here, we assessed relapse rates, persistence, and adherence of DMF and FTY in a Japanese real-world setting.

METHODS

A cohort study was conducted using a large Japanese claims database. We included MS patients aged ≥18 years who initiated DMF or FTY between February 22, 2017 (the launch of DMF in Japan), and February 29, 2020. The primary effectiveness outcome was MS relapse, defined as treatment with intravenous methylprednisolone at a dosage of ≥250 mg/day for at least 3 consecutive days. Annualized relapse rates (ARRs) and ARR ratios for DMF and FTY groups were estimated using a Poisson regression model. Secondary outcomes included persistence and adherence. Persistence was evaluated using Kaplan-Meier survival analysis and a Cox proportional hazards model. Adherence was assessed by the proportion of days covered (PDC) at 30, 60, 90, 180, and 365 days. Propensity score overlap weighting was used to adjust for baseline covariates between groups.

RESULTS

143 patients in the DMF group (mean age 41.45 years, 59 males, mean number of MS relapses at baseline: 0.54) and 36 in the FTY group (mean age 39.89 years, 18 males, mean number of MS relapses at baseline: 0.56) met the eligibility criteria. After overlap weighting, covariates were well balanced. The ARR was 0.05 (95 % confidence interval, 0.02-0.16) in the DMF group and 0.15 (0.05-0.45) in the FTY group, with a ratio of 0.34 (0.07-1.63). The 1-year persistence was 0.84 (0.74-0.95) for the DMF group and 0.53 (0.37-0.78) for the FTY group, resulting in a hazard ratio of 0.28 (0.11-0.70). Median PDC for the DMF group was 0.90 (interquartile range, 0.77-1.00) at 30 days, which improved over time as treatment duration increased to reach 0.98 (0.94-0.98) at 365 days. In contrast, median PDC for the FTY group remained constant at 0.98-1.00 across all time points.

CONCLUSION

The effectiveness, as measured by ARRs, was comparable between the DMF and FTY groups, although a small but clinically significant difference may not have been detected in this study. Persistence was higher in the DMF group than in the FTY group. Adherence was high for both drugs, but some patients treated with DMF had low adherence early in treatment.

Efficacy, safety, and tolerability of adjunctive Lacosamide therapy for focal seizures in young children aged ≥1 month to ≤4 years: A real-world study

AIMS

To evaluate the efficacy, safety, and tolerability of adjunctive lacosamide therapy against focal seizures in young children (1 month - 4 years).

METHODS

This non-randomized, open-label, and self-controlled real-world study included 105 children (1 month-4 years) with focal seizures treated with adjunctive lacosamide therapy at Children's Hospital of Chongqing Medical University.

RESULTS

(1) The 50% response rates at 3, 6, 9, and 12 months of follow-up were 58.1%, 61.0%, 57.1%, and 56.2%, while the seizure-free rates were 27.6%, 34.3%, 32.4%, and 37.1%, respectively. The 50% response rate of the first addition of lacosamide for focal seizures was much higher than the second and later added treatment at 3 months (p = 0.038). After 1 year of follow-up, these children showed an improvement in neurodevelopmental levels (p < 0.05). (2) Lacosamide retention rate was 72.7% (64/88) after 1 year of follow-up. Lack of efficacy and serious adverse events were independent risk factors for the lacosamide retention rate. (3) During adjunctive lacosamide therapy, 13 (12.4%) patients reported adverse events and five (4.7%) patients withdrew due to adverse events, including vomiting drowsiness, ataxia (0.94%), neck itching with eczema (0.94%), irritability (1.88%), and gastrointestinal discomfort (0.94%).

CONCLUSION

Adjunctive lacosamide therapy was effective, safe, and well-tolerated in young Chinese children with focal seizures in this study.

Risk assessment of arrhythmias related to three antiseizure medications: a systematic review and single-arm meta-analysis

Objective

Antiseizure medications (ASMs) are first line therapy for seizure disorders. Their effects on arrhythmias, especially the risk of arrhythmias associated with lacosamide (LCM), levetiracetam (LEV), and perampanel (PER), have been intensely investigated.

Methods

We searched four databases (PubMed, EMBASE, Cochrane Library, and Web of Science) until August 6, 2023. We used a common effects model and reported data as pooled incidence with 95% CIs. Meta-analyses were conducted to elucidate the risk of arrhythmias with different drugs, and Egger's regression was performed to detect publication bias analysis.

Results

We included 11 clinical trials with 1,031 participants. The pooled incidence of arrhythmias in the LEV group was 0.005 (95% CI: 0.001-0.013), while it was 0.014 in the LCM group (95% CI: 0.003-0.030). Publication bias analyses indicated no significant bias in the LEV group (t = 0.02, df = 4, p-value = 0.9852) but a significant bias in the LCM group (t = 5.94, df = 3, p-value = 0.0095). We corrected for this bias in the LCM group using the trim-and-fill method, which yielded a similar pooled incidence of 0.0137 (95% CI: 0.0036-0.0280), indicating good reliability. Due to insufficient studies, we could not conduct a meta-analysis for PER, and we analyzed them in our systematic review.

Conclusion

The use of LCM significantly elevated the risk of arrhythmias, while LEV had non-significant arrhythmogenic effects. As for the arrhythmogenic effects of PER, more clinical trials are needed in the future.

Initial therapeutic target attainment of perampanel in pediatric patients with epilepsy

Perampanel is a promising option for the treatment of pediatric epilepsy, but its plasma concentration varies among patients. This retrospective study aimed to investigate the initial target attainment of perampanel plasma concentration in pediatric patients with epilepsy in China. Inpatients admitted from January 2020 to December 2021 in a tertiary hospital were retrospectively included according to pre-set criteria. Demographic characteristics of patients and dosing strategies and therapeutic drug monitoring results were collected. A total of 137 pediatric patients (84 females and 53 males, aged from 0.6 to 16.4 years) were include for analysis. The perampanel concentrations varied greatly from 60 to 1,560 mg/L among patients, but 89.8% had suitable perampanel concentrations (100-1,000 ng/mL). The concomitant use of enzyme-inductive antiepileptic drugs (AEDs) was the only identified risk factor associated with target nonattainment (OR = 5.92, 95% confidence interval 1.68-20.9). Initial perampanel target attainment in pediatric patients is satisfactory. Routine therapeutic drug monitoring to achieved the suggested concentration range for these patients may be unnecessary, except for those receiving combined enzyme inductive AEDs.