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Cercos M, Seqat I, Facile A, Vial T, Auffret M. Lacosamide use during breastfeeding: A case report and a literature review. Fundam Clin Pharmacol 2024; 38:575-578. [PMID: 38054544 DOI: 10.1111/fcp.12971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/08/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023]
Abstract
Lacosamide, a voltage-gated sodium channel inhibitor, is an anti-seizure medication (ASM) from the age of 4. We report on the case of a woman treated with lacosamide for pharmacoresistant epilepsy who breastfed her infant for more than 6 months after birth. The infant's blood concentrations of lacosamide were 2.4 mg/L on Day 1 and less than 1 mg/L on Day 10 (reference values are 1-10 mg/L). No adverse drug reactions (ADRs) were reported for the infant. Eight cases of breastfeeding by mothers receiving lacosamide are described in the literature. These data confirm that a significant amount of lacosamide seems to pass into breast milk, with a relative infant dose (RID) above 20% in two cases but a low RID (1.8%) in another case. Nevertheless, blood tests, performed in two breastfed infants, revealed low concentrations of lacosamide. No ADRs were reported in eight of the breastfed infants; however, one infant, whose mother was also treated with levetiracetam, presented poor feeding and sleepiness at Day 15 of life. Given the well-known benefits of breastfeeding for both mothers and their infants, as well as the above reassuring data, breastfeeding of healthy full-term infants could be possible for mothers on lacosamide monotherapy. Nonetheless, relatives should be warned that data concerning the safety of lacosamide during breastfeeding are scarce and that long-term neurodevelopment outcomes in breastfed children are unknown. Clinical monitoring of breastfed infants for drowsiness, adequate weight gain, or cutaneous rash is recommended. Additionally, the infants' serum levels should be measured in case of an unexplained adverse reaction.
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Affiliation(s)
- Morgan Cercos
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Hospices Civils de Lyon, Lyon, France
| | - Ines Seqat
- Service de neurologie fonctionnelle et épileptologie, hôpital neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Anthony Facile
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Hospices Civils de Lyon, Lyon, France
| | - Thierry Vial
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Hospices Civils de Lyon, Lyon, France
| | - Marine Auffret
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Hospices Civils de Lyon, Lyon, France
- UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Université Lyon 1, Lyon, France
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Kaur M, Utidjian L, Abend NS, Dickinson K, Roebling R, McDonald J, Maltenfort MG, Foskett N, Elmoufti S, Guerriero RM, Jain BG, Pajor NM, Rao S, Shellhaas RA, Slaughter L, Forrest CB. Retrospective Multicenter Cohort Study on Safety and Electroencephalographic Response to Lacosamide for Neonatal Seizures. Pediatr Neurol 2024; 155:18-25. [PMID: 38579433 DOI: 10.1016/j.pediatrneurol.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 02/06/2024] [Accepted: 03/07/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND There is growing evidence supporting the safety and effectiveness of lacosamide in older children. However, minimal data are available for neonates. We aimed to determine the incidence of adverse events associated with lacosamide use and explore the electroencephalographic seizure response to lacosamide in neonates. METHODS A retrospective cohort study was conducted using data from seven pediatric hospitals from January 2009 to February 2020. For safety outcomes, neonates were followed for ≤30 days from index date. Electroencephalographic response of lacosamide was evaluated based on electroencephalographic reports for ≤3 days. RESULTS Among 47 neonates, 98% received the first lacosamide dose in the intensive care units. During the median follow-up of 12 days, 19% of neonates died, and the crude incidence rate per 1000 patient-days (95% confidence interval) of the adverse events by diagnostic categories ranged from 2.8 (0.3, 10.2) for blood or lymphatic system disorders and nervous system disorders to 10.5 (4.2, 21.6) for cardiac disorders. Electroencephalographic seizures were observed in 31 of 34 patients with available electroencephalographic data on the index date. There was seizure improvement in 29% of neonates on day 1 and also in 29% of neonates on day 2. On day 3, there was no change in 50% of neonates and unknown change in 50% of neonates. CONCLUSIONS The results are reassuring regarding the safety of lacosamide in neonates. Although some neonates had fewer seizures after lacosamide administration, the lack of a comparator arm and reliance on qualitative statements in electroencephalographic reports limit the preliminary efficacy results.
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Affiliation(s)
- Moninder Kaur
- RWE Neurology, UCB Pharma Ltd, Slough, UK; Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Levon Utidjian
- The Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nicholas S Abend
- Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kimberley Dickinson
- The Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Robert Roebling
- Epilepsy and Rare Syndrome Organisation, UCB Pharma, Monheim am Rhein, Germany
| | - Jill McDonald
- The Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mitchell G Maltenfort
- The Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Sami Elmoufti
- Biometric & Quantitative Services-Launch Statistics, UCB Pharma, Morrisville, North Carolina
| | - Rejean M Guerriero
- Division of Pediatric Neurology, Department of Neurology, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Badal G Jain
- Division of Neurology, Department of Pediatrics, Nemours Children's Health, Wilmington, Delaware
| | - Nathan M Pajor
- Divisions of Pulmonary Medicine and Biomedical Informatics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Suchitra Rao
- Department of Pediatrics (Infectious Diseases, Epidemiology and Hospital Medicine), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - Renée A Shellhaas
- Division of Pediatric Neurology, Department of Neurology, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Laurel Slaughter
- Division of Child Neurology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Christopher B Forrest
- The Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Kim HK, Jang KS, Kim DW. Comparative analysis of adverse drug reactions associated with new antiseizure medications from the Korea Adverse Event Reporting System database. Epilepsy Behav 2024; 154:109784. [PMID: 38636107 DOI: 10.1016/j.yebeh.2024.109784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/30/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE This study aimed to compare and characterize the safety profiles of new antiseizure medications (ASMs) using a nationwide pharmacovigilance database from a long-term perspective in Korea. METHODS We reviewed adverse event reports from the Korea Adverse Event Reporting System database between January 2013 and December 2022 for descriptive analysis of six new ASMs (lacosamide, levetiracetam, lamotrigine, oxcarbazepine, topiramate, and zonisamide). We investigated the frequency and characteristics of adverse drug reactions (ADRs) based on the MedDRA terminology, system organ classes, and modified WHO classification. RESULTS We identified 5,733 reported cases of ADRs. The commonly reported ADRs associated with total ASMs were rash/urticaria (1,822, 31.8 %), dizziness (409, 7.1 %), somnolence/drowsiness (311, 5.4 %), and hepatotoxic effects (273, 4.8 %). Type B (idiosyncratic) effects (2,932; 51.1 %) were more commonly reported than Type A (related to known drug mechanisms) effects (2,613; 45.6 %). Skin and subcutaneous tissue disorders and type B effects were most commonly reported for lamotrigine and oxcarbazepine, whereas nervous system disorders and type A effects were most commonly reported for lacosamide, topiramate, and zonisamide. The pediatric group (<18 years) exhibited skin and subcutaneous tissue disorders and type B effects relatively more frequently than the adult and older adult groups. CONCLUSION Hypersensitivity skin reactions and type B effects remained significant ADRs in the new ASMs; however, type A effects were more commonly reported in some ASMs. The pediatric group showed a higher rate of type B effects. Overall, new ASMs should also be used with caution.
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Affiliation(s)
- Hyun Kyung Kim
- Department of Neurology, National Medical Center, Seoul, South Korea
| | - Kyung Sik Jang
- Department of Neurology, National Medical Center, Seoul, South Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, South Korea.
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Perucca P, Bourikas D, Voinescu PE, Vadlamudi L, Chellun D, Kumke T, Werhahn KJ, Schmitz B. Lacosamide and pregnancy: Data from spontaneous and solicited reports. Epilepsia 2024; 65:1275-1284. [PMID: 38411300 DOI: 10.1111/epi.17924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE In pregnancy, it is important to balance the risks of uncontrolled epileptic seizures to the mother and fetus against the potential teratogenic effects of antiseizure medications. Data are limited on pregnancy outcomes among patients taking lacosamide (LCM), particularly when taken as monotherapy. The objective of this analysis was to evaluate the pregnancy outcomes of LCM-exposed pregnancies. METHODS This analysis included all reports in the UCB Pharma pharmacovigilance database of exposure to LCM during pregnancy from spontaneous sources (routine clinical settings) or solicited reports from interventional clinical studies and noninterventional postmarketing studies. Prospective and retrospective reports were analyzed separately. RESULTS At the data cutoff (August 31, 2021), there were 202 prospective pregnancy cases with maternal exposure to LCM and known outcomes. Among these cases, 44 (21.8%) patients received LCM monotherapy and 158 (78.2%) received LCM polytherapy. Most patients received LCM during the first trimester (LCM monotherapy: 39 [88.6%]; LCM polytherapy: 143 [90.5%]). From the prospective pregnancy cases with maternal LCM exposure, there were 204 reported outcomes (two twin pregnancies occurred in the polytherapy group). The proportion of live births was 84.1% (37/44) in patients who received LCM as monotherapy, and 76.3% (122/160) for LCM polytherapy. The overall proportion of abortions (for any reason) was 15.9% (7/44) with LCM monotherapy, and 22.5% (36/160) with LCM polytherapy. Congenital malformations were reported in 2.3% (1/44) of known pregnancy outcomes with maternal exposure to LCM monotherapy, and 6.9% (11/160) with polytherapy. SIGNIFICANCE Our preliminary data do not raise major concerns on the use of LCM during pregnancy. Most pregnancies with LCM exposure resulted in healthy live births, and no new safety issues were identified. These findings should be interpreted with caution, as additional data are needed to fully evaluate the safety profile of LCM in pregnancy.
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Affiliation(s)
- Piero Perucca
- Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Melbourne, Victoria, Australia
- Bladin-Berkovic Comprehensive Epilepsy Program, Austin Health, Melbourne, Victoria, Australia
| | | | - P Emanuela Voinescu
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lata Vadlamudi
- University of Queensland Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia
- Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Guo Y, Liu Y, Li D, Wang X, Huang S, Yang L. Clinical observation and analysis of rash caused by lacosamide in children with epilepsy. Seizure 2024; 117:105-110. [PMID: 38367318 DOI: 10.1016/j.seizure.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/25/2024] [Accepted: 02/11/2024] [Indexed: 02/19/2024] Open
Abstract
PURPOSE To draw clinical attention to rashes caused by lacosamide. METHODS This retrospective analysis included patients admitted to the Department of Pediatrics, Second Affiliated Hospital of Xi'an Jiaotong University between January 2021 and September 2023. We focused on patients who developed rashes after lacosamide treatment and analyzed all patients who exhibited rashes after lacosamide treatment to analyze the risk factors. RESULTS In total, 190 patients received lacosamide, of whom four developed allergies (2.1 %). Three patients had severe rashes, and two patients had high fever. All of these adverse events improved after the withdrawal of lacosamide. Of the 13 patients reported to date, including the four patients in this study, eight used various antiseizure medicines, including seven patients who used four or more antiseizure medicines. Four patients underwent testing for HLA-B*1502, and two patients were positive. Patients developed rashes within 1-10 days after treatment initiation, and the duration of the rash ranged 2-37 days. CONCLUSIONS Lacosamide-induced rash was detected in 2.1 % of patients in our cohort. Rashes are potentially serious, and prompt evaluation is required. Rashes are more likely to occur when multiple antiseizure medicines are used simultaneously, typically within 10 days of treatment initiation.
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Affiliation(s)
- Yingying Guo
- Department of Pediatric, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an 710004 Shaanxi Province, China
| | - Yu Liu
- Department of Pediatric, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an 710004 Shaanxi Province, China
| | - Dan Li
- Department of Pediatric, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an 710004 Shaanxi Province, China
| | - Xueying Wang
- Department of Pediatric, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an 710004 Shaanxi Province, China
| | - Shaoping Huang
- Department of Pediatric, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an 710004 Shaanxi Province, China
| | - Lin Yang
- Department of Pediatric, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an 710004 Shaanxi Province, China.
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Makedonska I, Ng YT, Beller C, Bozorg A, Csikós J, McClung C, Moeltgen H, Farkas MK. Efficacy and tolerability of adjunctive lacosamide in patients aged <4 years with focal seizures. Ann Clin Transl Neurol 2024; 11:768-779. [PMID: 38375995 DOI: 10.1002/acn3.52004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/29/2023] [Accepted: 12/26/2023] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE Primary objective was to evaluate efficacy of lacosamide administered concomitantly with 1-3 antiseizure medications in young children with uncontrolled focal (partial-onset) seizures. METHODS Double-blind, parallel-group trial (SP0967: NCT02477839/2013-000717-20) conducted between June 2015 and May 2020 at hospitals and clinics in 25 countries. Patients (aged ≥1 month to <4 years) with uncontrolled focal seizures were randomized 1:1 to adjunctive lacosamide or placebo using an interactive voice/web response system and stratified by age. After a 20-day titration period, patients who reached target-dose range (8-12 mg/kg/day) entered a 7-day maintenance period. Region-specific primary efficacy variables were based on ≤72-h video-electroencephalograms: change in average daily frequency (ADF) of electrographic focal seizures as measured on end-of-maintenance video-electroencephalogram versus end-of-baseline video-electroencephalogram (United States); 50% responder rate (≥50% reduction in ADF of focal seizures) during maintenance (European Union). RESULTS In total, 255 patients were randomized (lacosamide/placebo: 128/127) and received ≥1 trial medication dose. Percentage reduction in ADF of focal seizures for lacosamide (116 patients) versus placebo (120 patients) was 3.2% (95% confidence interval = -13.6 to 17.5, p = 0.69). 50% responder rate was 41.4% for lacosamide (116 patients), 37.5% for placebo (120 patients) (p = 0.58). Treatment-emergent adverse events were reported by 44.5% of lacosamide-treated patients (placebo 51.2%). INTERPRETATION Adjunctive lacosamide did not show superior efficacy versus placebo in young children with focal seizures. However, efficacy variables were potentially affected by high variability and low reliability between readers in video-electroencephalogram interpretation. Lacosamide was generally well tolerated; safety profile was acceptable and consistent with that in adults and children aged ≥4 years.
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Affiliation(s)
- Iryna Makedonska
- Municipal Non-profit Enterprise City Children's Clinical Hospital #6 of Dnipro City Council, Dnipro, Ukraine
| | - Yu-Tze Ng
- Baylor College of Medicine/The Children's Hospital of San Antonio, San Antonio, Texas, USA
| | | | - Ali Bozorg
- UCB Pharma, Morrisville, North Carolina, USA
| | | | | | | | - Mark Kristof Farkas
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
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Bosak M, Dziedzic R, Matwiej K, Słowik A. Outcomes following exposure to lacosamide monotherapy during pregnancy and breastfeeding - a prospective case series. Neurol Neurochir Pol 2024; 58:203-206. [PMID: 38305480 DOI: 10.5603/pjnns.97120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 02/03/2024]
Abstract
AIM OF THE STUDY To evaluate the safety of lacosamide (LCM) monotherapy during pregnancy and breastfeeding. MATERIAL AND METHODS Patients taking LCM monotherapy treated at the university epilepsy clinic were prospectively followed up during pregnancy, delivery, and breastfeeding. Data on seizure frequency, LCM dosage, pregnancy course, delivery and breastfeeding, birth outcome, congenital malformation, and development of newborns was collected. RESULTS Four pregnancies in three patients with refractory focal epilepsy treated with LCM monotherapy were reported. One of these pregnancies ended in a miscarriage during the seventh week of gestation. The average daily LCM dose at the time of conception was 300 mg. Treatment with LCM was continued throughout pregnancy and breastfeeding. The dose of LCM was increased in two pregnancies: in one case following a seizure relapse, and in the other case as a preventive measure to avoid an increase in seizure frequency. Seizure frequency remained stable during pregnancy in two cases. All deliveries were carried out via caesarean section, with an average gestational age at birth of 37.6 weeks. The Apgar score was 10 in all newborns, and no congenital malformations were detected. At the age of 12 months, normal developmental milestones were reached. Infants were breastfed without any complications. CONCLUSIONS AND CLINICAL IMPLICATIONS This case series adds to a growing body of evidence suggesting the relative safety of LCM monotherapy throughout pregnancy and breastfeeding.
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Affiliation(s)
- Magdalena Bosak
- Collegium Medicum, Jagiellonian University of Krakow, Krakow, Poland.
| | - Radosław Dziedzic
- Collegium Medicum, Jagiellonian University of Krakow, Krakow, Poland
| | - Katarzyna Matwiej
- Collegium Medicum, Jagiellonian University of Krakow, Krakow, Poland
| | - Agnieszka Słowik
- Collegium Medicum, Jagiellonian University of Krakow, Krakow, Poland
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Lumley LA, Nguyen DA, de Araujo Furtado M, Niquet J, Linz EO, Schultz CR, Stone MF, Wasterlain CG. Efficacy of Lacosamide and Rufinamide as Adjuncts to Midazolam-Ketamine Treatment Against Cholinergic-Induced Status Epilepticus in Rats. J Pharmacol Exp Ther 2024; 388:347-357. [PMID: 37977809 PMCID: PMC10801783 DOI: 10.1124/jpet.123.001789] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023] Open
Abstract
Benzodiazepine pharmacoresistance develops when treatment of status epilepticus (SE) is delayed. This response may result from gamma-aminobutyric acid A receptors (GABAAR) internalization that follows prolonged SE; this receptor trafficking results in fewer GABAAR in the synapse to restore inhibition. Increase in synaptic N-methyl-D-aspartate receptors (NMDAR) also occurs in rodent models of SE. Lacosamide, a third-generation antiseizure medication (ASM), acts on the slow inactivation of voltage-gated sodium channels. Another ASM, rufinamide, similarly acts on sodium channels by extending the duration of time spent in the inactivation stage. Combination therapy of the benzodiazepine midazolam, NMDAR antagonist ketamine, and ASMs lacosamide (or rufinamide) was investigated for efficacy against soman (GD)-induced SE and neuropathology. Adult male rats implanted with telemetry transmitters for monitoring electroencephalographic (EEG) activity were exposed to a seizure-inducing dose of GD and treated with an admix of atropine sulfate and HI-6 1 minute later and with midazolam monotherapy or combination therapy 40 minutes after EEG seizure onset. Rats were monitored continuously for seizure activity for two weeks, after which brains were processed for assessment of neurodegeneration, neuronal loss, and neuroinflammatory responses. Simultaneous administration of midazolam, ketamine, and lacosamide (or rufinamide) was more protective against GD-induced SE compared with midazolam monotherapy. In general, lacosamide triple therapy had more positive outcomes on measures of epileptogenesis, EEG power integral, and the number of brain regions protected from neuropathology compared with rats treated with rufinamide triple therapy. Overall, both drugs were well tolerated in these combination models. SIGNIFICANCE STATEMENT: We currently report on improved efficacy of antiseizure medications lacosamide and rufinamide, each administered in combination with ketamine (NMDAR antagonist) and midazolam (benzodiazepine), in combatting soman (GD)-induced seizure, epileptogenesis, and brain pathology over that provided by midazolam monotherapy, or dual therapy of midazolam and lacosamide (or rufinamide) in rats. Administration of lacosamide as adjunct to midazolam and ketamine was particularly effective against GD-induced toxicity. However, protection was incomplete, suggesting the need for further study.
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Affiliation(s)
- Lucille A Lumley
- Neuroscience Department, U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland (L.A.L., D.A.N., E.O.L., C.R.S., M.F.S.); BioSEaD, LLC, Rockville, Maryland (M.d.A.F.); and Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, and Epilepsy Research Laboratory, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California (J.N., C.G.W.)
| | - Donna A Nguyen
- Neuroscience Department, U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland (L.A.L., D.A.N., E.O.L., C.R.S., M.F.S.); BioSEaD, LLC, Rockville, Maryland (M.d.A.F.); and Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, and Epilepsy Research Laboratory, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California (J.N., C.G.W.)
| | - Marcio de Araujo Furtado
- Neuroscience Department, U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland (L.A.L., D.A.N., E.O.L., C.R.S., M.F.S.); BioSEaD, LLC, Rockville, Maryland (M.d.A.F.); and Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, and Epilepsy Research Laboratory, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California (J.N., C.G.W.)
| | - Jerome Niquet
- Neuroscience Department, U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland (L.A.L., D.A.N., E.O.L., C.R.S., M.F.S.); BioSEaD, LLC, Rockville, Maryland (M.d.A.F.); and Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, and Epilepsy Research Laboratory, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California (J.N., C.G.W.)
| | - Emily O Linz
- Neuroscience Department, U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland (L.A.L., D.A.N., E.O.L., C.R.S., M.F.S.); BioSEaD, LLC, Rockville, Maryland (M.d.A.F.); and Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, and Epilepsy Research Laboratory, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California (J.N., C.G.W.)
| | - Caroline R Schultz
- Neuroscience Department, U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland (L.A.L., D.A.N., E.O.L., C.R.S., M.F.S.); BioSEaD, LLC, Rockville, Maryland (M.d.A.F.); and Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, and Epilepsy Research Laboratory, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California (J.N., C.G.W.)
| | - Michael F Stone
- Neuroscience Department, U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland (L.A.L., D.A.N., E.O.L., C.R.S., M.F.S.); BioSEaD, LLC, Rockville, Maryland (M.d.A.F.); and Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, and Epilepsy Research Laboratory, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California (J.N., C.G.W.)
| | - Claude G Wasterlain
- Neuroscience Department, U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland (L.A.L., D.A.N., E.O.L., C.R.S., M.F.S.); BioSEaD, LLC, Rockville, Maryland (M.d.A.F.); and Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, and Epilepsy Research Laboratory, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California (J.N., C.G.W.)
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9
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Huberman MA, Mallar C, Kalika PM. Neonatal Cardiac Arrest Following Lacosamide Treatment: A Case Report. Pediatr Neurol 2023; 149:184-186. [PMID: 37913565 DOI: 10.1016/j.pediatrneurol.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 08/18/2023] [Accepted: 09/11/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Lacosamide is an antiepileptic drug with US Food and Drug Administration approval for the treatment of partial-onset seizures in patients older than one month. Lacosamide works by selective enhancement of proteins that induce preferential slow promotion of sodium channels to the hyperpolarized inactive state. Lacosamide is generally well-tolerated; however, clinical and nonclinical studies have linked its use with cardiac side effects including PR prolongation and atrioventricular (AV) block. RESULTS We present the case of a three-week-old female neonatal patient born at 25 weeks' gestation who developed second-degree AV heart block and cardiac arrest after initiating lacosamide therapy. The patient was being treated for neonatal seizure complicated by intraventricular hemorrhage (grade II) and electrolyte disturbances with phenobarbital, levetiracetam, and phenytoin. Before addition of lacosamide therapy, the patient had an unremarkable electrocardiogram and no known cardiac risk factors for lacosamide. After medication discontinuation, the patient experienced no reoccurring episodes or other cardiac events. CONCLUSION Use of lacosamide for neonatal populations is currently under evaluation. This is the first report of adverse cardiac event (AV block) in the setting of neonatal lacosamide use. Risk of future adverse cardiac events should be evaluated when determining the safety and efficacy of lacosamide in the neonatal population.
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Affiliation(s)
- Melissa Ann Huberman
- Department of Pediatric Neurology, University of Miami and Jackson Health System, Miami, Florida.
| | - Carolina Mallar
- Department of Pediatric Neurology, University of Miami and Jackson Health System, Miami, Florida
| | - Paige M Kalika
- Department of Pediatric Neurology, University of Miami and Jackson Health System, Miami, Florida
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10
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Auvin S, Arzimanoglou A, Beller C, Floricel F, Daniels T, Bozorg A. Safety, tolerability, and efficacy of adjunctive lacosamide in pediatric patients with epilepsy syndromes associated with generalized seizures: Phase 2, open-label exploratory trial. Epilepsia 2023; 64:2947-2957. [PMID: 37545406 DOI: 10.1111/epi.17741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE To evaluate the safety, tolerability, pharmacokinetics, and preliminary efficacy of lacosamide (LCM) (up to 12 mg/kg/day or 600 mg/day) as adjunctive therapy in pediatric patients with epilepsy syndromes associated with generalized seizures. METHODS Phase 2, multicenter, open-label exploratory trial (SP0966; NCT01969851; 2012-001446-18) of oral LCM for epilepsy syndromes associated with generalized seizures in pediatric patients ≥1 month to <18 years of age taking one to three concomitant antiseizure medications. The trial comprised a 6-week prospective baseline period, 6-week flexible titration period, and 12-week maintenance period. RESULTS Fifty-five patients (mean age: 9.2 years; 56.4% male) took at least one dose of LCM and had at least one post-baseline efficacy-related assessment. The median treatment duration was 127.0 days. There were no clinically significant mean or median changes or worsening from baseline to end of the titration period in the count of generalized spike-wave discharges per interpretable hour on 24-h ambulatory electroencephalogram recordings, or from baseline to the maintenance period in mean and median days with any generalized or focal to bilateral tonic-clonic seizures per 28 days. Treatment-emergent adverse events (TEAEs) were reported by 49 patients (89.1%), and three patients (5.5%) discontinued due to TEAEs. The median change and median percentage change in days with any generalized or focal to bilateral tonic-clonic seizures per 28 days from baseline to the maintenance period were both 0. Trends toward improvement (decrease) were observed in median change and median percentage change in days with each individual seizure type (absence, myoclonic, clonic, tonic, tonic-clonic, atonic, and focal to bilateral tonic-clonic) per 28 days. SIGNIFICANCE Safety findings were consistent with the known safety profile of LCM and were as expected for the pediatric population. There was no worsening of generalized seizures with LCM. Limitations include the inability to correlate spike and wave data with clinical outcomes, and the lack of similar studies against which the results can be compared.
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Affiliation(s)
- Stéphane Auvin
- Université Paris-Cité, INSERM NeuroDiderot, Paris, France
- Pediatric Neurology Department, APHP, Robert Debré University Hospital, ERN EpiCARE member, Paris, France
- Institut Universitaire de France (IUF), Paris, France
| | - Alexis Arzimanoglou
- Paediatric Clinical Epileptology and Neurophysiology Department, ERN EpiCARE member, University Hospitals of Lyon (HCL), Lyon, France
- Epilepsy Research Unit, San Juan de Dios Children's Hospital, ERN EpiCARE member, Barcelona, Spain
| | | | | | | | - Ali Bozorg
- UCB Pharma, Morrisville, North Carolina, USA
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11
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Ragoonanan D, Tran N, Levesque M. Safety and Tolerability of Intravenous Push Lacosamide and Levetiracetam. J Pharm Pract 2023; 36:1056-1060. [PMID: 35348010 DOI: 10.1177/08971900221087955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Lacosamide and levetiracetam are antiseizure medications (ASMs) commonly utilized in the treatment and prevention of seizures. Historically, these agents have been administered as slow IV infusions after further dilution. Recent literature suggests that rapid administration via undiluted IV push may be safe and may increase efficiency of administration. Objective: This study aimed to evaluate the safety and tolerability of undiluted IV push lacosamide and levetiracetam over 5 min. Methods: This study was conducted as a single-centered, retrospective, observational cohort that analyzed the rapid administration of undiluted lacosamide and levetiracetam. Adult patients admitted from September 1st, 2019, to May 31st, 2020, receiving at least one administration of IV push lacosamide at any dose or levetiracetam at doses ≤ 1500 mg were evaluated. The primary safety outcomes were the incidence of hypotension and bradycardia. Results: A total of 86 subjects were evaluated; 36 patients were administered lacosamide, and 50 patients were administered levetiracetam. Hypotension or bradycardia occurred in 6 patients in the lacosamide group (16.6%) and 6 patients in the levetiracetam group (12.0%). There were no reported infusion site reactions. Among the subjects who received lacosamide and had a 12-lead electrocardiogram (EKG), there were no reported incidences of a prolonged PR interval. Conclusions: In this safety-analysis cohort, undiluted lacosamide and levetiracetam were not associated with significant adverse events when administered via IV push over 5 min. This seems to be a safe alternative method of administration to intermittent infusion. A larger, prospective cohort is needed to confirm these findings.
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Affiliation(s)
- David Ragoonanan
- Pharmacy Department, Sarasota Memorial Hospital, Sarasota, FL, USA
| | - Nicolas Tran
- Pharmacy Department, Tampa General Hospital, Tampa, FL, USA
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12
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Watson P, Lamiaux M, Lebas D, Modiano P. Stevens-Johnson syndrome induced by lacosamide: A rare adverse reaction. Ann Dermatol Venereol 2023; 150:223-224. [PMID: 37263864 DOI: 10.1016/j.annder.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/30/2022] [Accepted: 12/12/2022] [Indexed: 06/03/2023]
Affiliation(s)
- P Watson
- Groupe Hospitalier de l'Institut Catholique de Lille, Hôpital St-Vincent-De-Paul, Lille, France; Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
| | - M Lamiaux
- Groupe Hospitalier de l'Institut Catholique de Lille, Hôpital St-Vincent-De-Paul, Lille, France
| | - D Lebas
- Groupe Hospitalier de l'Institut Catholique de Lille, Hôpital St-Vincent-De-Paul, Lille, France
| | - P Modiano
- Groupe Hospitalier de l'Institut Catholique de Lille, Hôpital St-Vincent-De-Paul, Lille, France
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13
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Packard E, Kalayanamitra R, Shahid Z, Patel R, Roy J, Maddukari A, Groff A, Polimera H, Golamari R, Sahu N, Vunnam R, Bhatt D, Jain R. DRESS is a Mess: A Case of Cross Reactivity Between Lacosamide and Lamotrigine. S D Med 2021; 74:324-328. [PMID: 34449996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Drug reaction with eosinophilia with systemic symptoms (DRESS) syndrome is a rare drug reaction often presenting with both cutaneous manifestations and potentially life-threatening internal organ involvement. The precise incidence of DRESS is still unclear as it is easily missed due to its highly variable clinical presentation. However, with an expected mortality rate of approximately 10 percent, it is important for clinicians to be familiar with pharmacologic etiologies commonly implicated in the pathogenesis. We present a case of DRESS syndrome attributed to cross-reactivity between two commonly used anticonvulsants- lacosamide and lamotrigine.
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Affiliation(s)
- Elizabeth Packard
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | | | - Zainab Shahid
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania
| | - Ravi Patel
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Justin Roy
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Ashok Maddukari
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Andrew Groff
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Hyma Polimera
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Reshma Golamari
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Nitasa Sahu
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Rama Vunnam
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Dhirisha Bhatt
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Rohit Jain
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
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van Opijnen MP, van der Meer PB, Dirven L, Fiocco M, Kouwenhoven MCM, van den Bent MJ, Taphoorn MJB, Koekkoek JAF. The effectiveness of antiepileptic drug treatment in glioma patients: lamotrigine versus lacosamide. J Neurooncol 2021; 154:73-81. [PMID: 34196916 PMCID: PMC8367894 DOI: 10.1007/s11060-021-03800-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/25/2021] [Indexed: 11/30/2022]
Abstract
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. Supplementary Information The online version contains supplementary material available at 10.1007/s11060-021-03800-z.
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Affiliation(s)
- Mark P van Opijnen
- Department of Neurology, Leiden University Medical Center, PO BOX 9600, 2300 RC, Leiden, The Netherlands.
| | - Pim B van der Meer
- Department of Neurology, Leiden University Medical Center, PO BOX 9600, 2300 RC, Leiden, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, PO BOX 9600, 2300 RC, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Marta Fiocco
- Department of Biomedical Data Sciences, Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
- Mathematical Institute, Leiden University, Leiden, The Netherlands
| | - Mathilde C M Kouwenhoven
- Department of Neurology, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | | | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, PO BOX 9600, 2300 RC, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Johan A F Koekkoek
- Department of Neurology, Leiden University Medical Center, PO BOX 9600, 2300 RC, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
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Załuska-Ogryzek K, Marzęda P, Wróblewska-Łuczka P, Florek-Łuszczki M, Plewa Z, Bojar H, Zolkowska D, Łuszczki JJ. Interactions among Lacosamide and Second-Generation Antiepileptic Drugs in the Tonic-Clonic Seizure Model in Mice. Int J Mol Sci 2021; 22:ijms22115537. [PMID: 34073930 PMCID: PMC8197343 DOI: 10.3390/ijms22115537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 12/26/2022] Open
Abstract
Combination therapy with two or three antiseizure medications (ASMs) is sometimes a preferred method of treatment in epilepsy patients. (1) Background: To detect the most beneficial combination among three ASMs, a screen test evaluating in vivo interactions with respect to their anticonvulsant properties, was conducted on albino Swiss mice; (2) Methods: Classification of interactions among lacosamide (LCM) and selected second-generation ASMs (lamotrigine (LTG), pregabalin (PGB), oxcarbazepine (OXC), and topiramate (TPM)) was based on the isobolographic analysis in the mouse maximal electroshock-induced seizure (MES) model. Interactions among LCM and second-generation ASMs were visualized using a polygonogram; (3) Results: In the mouse MES model, synergy was observed for the combinations of LCM + TPM + PGB and LCM + OXC + PGB. Additivity was reported for the other combinations tested i.e., LCM + LTG + TPM, LCM + LTG + PGB, LCM + LTG + OXC, and LCM + OXC + TPM in this seizure model. No adverse effects associated with triple ASM combinations, containing LCM and second-generation ASMs were observed in mice; (4) Conclusions: The combination of LCM + TPM + PGB was the most beneficial combination among the tested in this study, offering synergistic suppression of tonic-clonic seizures in mice subjected to the MES model. Both the isobolographic analysis and polygonogram method can be recommended for experimental epileptology when classifying interactions among the ASMs.
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Affiliation(s)
- Katarzyna Załuska-Ogryzek
- Department of Pathophysiology, Medical University of Lublin, 20-090 Lublin, Poland; (K.Z.-O.); (P.M.); (P.W.-Ł.)
| | - Paweł Marzęda
- Department of Pathophysiology, Medical University of Lublin, 20-090 Lublin, Poland; (K.Z.-O.); (P.M.); (P.W.-Ł.)
| | - Paula Wróblewska-Łuczka
- Department of Pathophysiology, Medical University of Lublin, 20-090 Lublin, Poland; (K.Z.-O.); (P.M.); (P.W.-Ł.)
| | | | - Zbigniew Plewa
- Department of General, Oncological and Minimally Invasive Surgery, 1st Military Clinical Hospital, 20-048 Lublin, Poland;
| | - Hubert Bojar
- Department of Toxicology and Food Safety, Institute of Rural Health, 20-090 Lublin, Poland;
| | - Dorota Zolkowska
- Department of Neurology, UC Davis School of Medicine, Sacramento, CA 95816, USA;
| | - Jarogniew J. Łuszczki
- Department of Pathophysiology, Medical University of Lublin, 20-090 Lublin, Poland; (K.Z.-O.); (P.M.); (P.W.-Ł.)
- Isobolographic Analysis Laboratory, Institute of Rural Health, 20-090 Lublin, Poland
- Correspondence: ; Tel.: +48-81-448-65-03
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Abstract
BACKGROUND This is an updated version of the Cochrane review published in 2015. Around half of people with epilepsy will not achieve seizure freedom on their first antiepileptic drug; many will require add-on therapy. Around a third of people fail to achieve complete seizure freedom despite multiple antiepileptic drugs. Lacosamide has been licenced as an add-on therapy for drug-resistant focal epilepsy. OBJECTIVES To evaluate the efficacy and tolerability of lacosamide as an add-on therapy for children and adults with drug-resistant focal epilepsy. SEARCH METHODS We searched the following databases (22 August 2019): the Cochrane Register of Studies (CRS Web), including the Cochrane Epilepsy Group Specialized Register and the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid, 1946 to 20 August 2019), ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP), with no language restrictions. We contacted UCB Pharma (sponsors of lacosamide). SELECTION CRITERIA Randomised controlled trials of add-on lacosamide in people with drug-resistant focal epilepsy. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology, assessing the following outcomes: 50% or greater reduction in seizure frequency; seizure freedom; treatment withdrawal; adverse events; quality of life; and cognitive changes. The primary analyses were intention-to-treat. We estimated summary risk ratios (RR) for each outcome presented with 99% confidence intervals (CI), except for 50% or greater seizure reduction, seizure freedom and treatment withdrawal which were presented with 95% CIs. We performed subgroup analyses according to lacosamide dose and sensitivity analyses according to population age, whereby data from children were excluded from the meta-analysis. MAIN RESULTS We included five trials (2199 participants). The risk of bias for all studies was low to unclear. All studies were placebo-controlled and assessed doses from 200 mg to 600 mg per day. One study evaluated lacosamide in children; all other studies were in adults. Trial duration ranged from 24 to 26 weeks. All studies used adequate methods of randomisation and were double-blind. Overall, the certainty of the evidence for the outcomes was judged as moderate to high, with the exception of seizure freedom which was low. The RR for a 50% or greater reduction in seizure frequency for all doses of lacosamide compared with placebo was 1.79 (95% CI 1.55 to 2.08; 5 studies; 2199 participants; high-certainty evidence). The RR for seizure freedom for all doses of lacosamide compared with placebo was 2.27 (95% CI 1.35 to 3.83; 5 studies; 2199 participants; low-certainty evidence). The RR for treatment withdrawal for all doses of lacosamide compared with placebo was 1.57 (95% CI 1.24 to 1.98; 5 studies; 2199 participants; moderate-certainty evidence). The estimated effect size for most outcomes did not change considerably following sensitivity analysis. For seizure freedom, however, the RR nearly doubled upon the exclusion of data from children (RR 4.04, 95% CI 1.52 to 10.73). Adverse events associated with lacosamide included: abnormal co-ordination (RR 6.12, 99% CI 1.35 to 27.77), blurred vision (RR 4.65, 99% CI 1.24 to 17.37), diplopia (RR 5.59, 99% CI 2.27 to 13.79), dizziness (RR 2.96, 99% CI 2.09 to 4.20), nausea (RR 2.35, 99% CI 1.37 to 4.02), somnolence (RR 2.04, 99% CI 1.22 to 3.41), vomiting (RR 2.94, 99% CI 1.54 to 5.64), and number of participants experiencing one or more adverse events (RR 1.12, 99% CI 1.01 to 1.24). Adverse events that were not significant were: vertigo (RR 3.71, 99% CI 0.86 to 15.95), rash (RR 0.58, 99% CI 0.17 to 1.89), nasopharyngitis (RR 1.41, 99% CI 0.87 to 2.28), headache (RR 1.34, 99% CI 0.90 to 1.98), fatigue (RR 2.11, 99% CI 0.92 to 4.85), nystagmus (RR 1.47, 99% CI 0.61 to 3.52), and upper respiratory tract infection (RR 0.70, 99% CI 0.43 to 1.15). AUTHORS' CONCLUSIONS Lacosamide is effective and well-tolerated in the short term when used as add-on treatment for drug-resistant focal epilepsy. Lacosamide increases the number of people with 50% or greater reduction in seizure frequency and may increase seizure freedom, compared to placebo. Higher doses of lacosamide may be associated with higher rates of adverse events and treatment withdrawal. Additional evidence is required assessing the use of lacosamide in children and on longer-term efficacy and tolerability.
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Affiliation(s)
| | - Rebecca Bresnahan
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Conor S Gillespie
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Benedict D Michael
- Clinical Infection Microbiology and Neuroimmunology, Institute of Infection, Veterinary and Ecological Science, Liverpool, UK
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
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Goodnough R, Badea A, Geier C, Lynch KL, LeSaint KT. Lacosamide induced Brugada I morphology in the setting of septicemia: A case report. Medicine (Baltimore) 2021; 100:e25577. [PMID: 33950934 PMCID: PMC8104292 DOI: 10.1097/md.0000000000025577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/31/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Brugada syndrome may be unmasked by non-antiarrhythmic pharmaceuticals or drugs. Lacosamide is an antiepileptic agent with a novel mechanism of sodium channel inhibition and has the potential to cause cardiac sodium channel blockade. PATIENT CONCERNS In this report, we describe the case of patient with a history of a seizure disorder who presented with Brugada I electrocardiogram morphology in the setting of septicemia. DIAGNOSIS Brugada I electrocardiogram morphology was unmasked by lacosamide antiepileptic monotherapy. INTERVENTIONS Lacosamide therapy was discontinued. OUTCOMES Normalization of the electrocardiogram and resolution of Brugada morphology occurred on hospital day 1. CONCLUSION Caution should be exercised in the use of lacosamide in those at risk for conduction delay, or in combination therapy with medications that impair renal clearance, metabolism of lacosamide, or that display inherent sodium channel blocking properties.
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Affiliation(s)
- Robert Goodnough
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas
- Department of Laboratory Medicine
| | - Adina Badea
- Department of Laboratory Medicine
- Department of Pathology and Laboratory Medicine, Lifespan Academic Medical Center and Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Curtis Geier
- Department of Laboratory Medicine
- Department of Clinical Pharmacy
| | - Kara L. Lynch
- Department of Laboratory Medicine
- Department of Pathology and Laboratory Medicine, Lifespan Academic Medical Center and Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kathy T. LeSaint
- Department of Laboratory Medicine
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California
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Yamamoto Y, Terada K, Araki Y, Fukushima Y, Imai K, Kagawa Y, Takahashi Y. Therapeutic Monitoring of Lacosamide in Japanese Patients With Epilepsy: Clinical Response, Tolerability, and Optimal Therapeutic Range. Ther Drug Monit 2020; 42:754-759. [PMID: 32941398 DOI: 10.1097/ftd.0000000000000764] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lacosamide is a novel anticonvulsant that acts by enhancing sodium channel slow inactivation. The aims of this study were to evaluate the influence of concomitant antiepileptic drugs (AEDs) on serum lacosamide concentration and explore the relationship between lacosamide serum concentration and both clinical response and adverse effects. METHODS The authors analyzed 649 serum samples from 426 Japanese patients with epilepsy. The concentration-to-dose (CD) ratio of lacosamide was compared among patients on various AED regimens. Clinical information about seizure frequency and adverse events was obtained from clinical records. RESULTS In patients who did not receive enzyme-inducing AEDs, the CD ratio (mean ± SD) of lacosamide was 1.84 ± 0.68. By contrast, the CD ratio in patients who received phenytoin, carbamazepine, and phenobarbital was 1.42 ± 0.66 (22.8% lower), 1.46 ± 0.40 (20.7% lower), and 1.36 ± 0.38 (26.1% lower), respectively. Seventy-four patients (17.3%) achieved >50% seizure reduction. The median lacosamide concentration in patients who received and did not receive a sodium channel blocker was 6.6 mcg/mL (26.4 μmol/L) and 8.4 mcg/mL (33.6 μmol/L), respectively. Adverse events, including dizziness, somnolence, diplopia, and anorexia, were reported by 70 patients (16.4%). The incidence rate in patients treated with sodium channel blockers was significantly higher than that in patients not treated with these drugs (21.1% vs. 10.3%; P < 0.005), and the median lacosamide concentration in these patient groups was 5.1 (20.4 μmol/L) and 7.5 mcg/mL (30 μmol/L), respectively. CONCLUSIONS Therapeutic drug monitoring of lacosamide is clinically useful because it allows physicians to estimate the extent of drug interactions and adjust the dose in individual AED regimens.
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Affiliation(s)
- Yoshiaki Yamamoto
- Department of Clinical Research, NHO, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama
- Department of Clinical Pharmaceutics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Yada; and
| | - Kiyohito Terada
- Department of Clinical Research, NHO, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama
| | - Yasukiyo Araki
- Department of Clinical Research, NHO, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama
| | - Yutaro Fukushima
- Department of Clinical Research, NHO, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama
| | - Katsumi Imai
- Department of Clinical Research, NHO, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama
| | - Yoshiyuki Kagawa
- Department of Clinical Pharmaceutics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Yada; and
- Laboratory of Clinical Pharmacokinetics and Drug Safety, Shizuoka General Hospital, Kita Ando, Shizuoka, Japan
| | - Yukitoshi Takahashi
- Department of Clinical Research, NHO, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Urushiyama
- Department of Clinical Pharmaceutics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Yada; and
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Geitona M, Stamuli E, Giannakodimos S, Kimiskidis VK, Kountouris V, Charokopou M, Christou P. Lacosamide as a first-line treatment option in focal epilepsy: a cost-utility analysis for the Greek healthcare system. J Med Econ 2019; 22:359-364. [PMID: 30652931 DOI: 10.1080/13696998.2019.1571499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND AIMS Epilepsy is the most common serious neurological disorder worldwide. Approximately 40% of patients with focal epileptic seizures remain uncontrolled with antiepileptic drug (AED) monotherapy or polytherapy. Lacosamide has been recently approved by the European Medicines Agency as monotherapy for the treatment of focal seizures. The aim of this study was to estimate the cost-effectiveness of lacosamide compared with zonisamide as first-line treatment of focal epilepsy in patients with epilepsy aged ≥ 16 years to inform clinical decision-making in Greece. METHODS A discrete event simulation model was adapted to reflect treatment pathways and resource use within the Greek national healthcare system, as specified by clinical experts. The model captures time-varying events and patient characteristics. Clinical inputs were sourced from pivotal trials and a network meta-analysis comparing lacosamide with other AEDs. The model predicts disease progression and seizures, relevant and most common adverse events, withdrawal due to lack of efficacy or adverse events, and epilepsy-specific and all-cause mortality over a 2-year time horizon. Unit costs were retrieved from published Greek sources. Health outcomes were measured as quality-adjusted life years (QALYs); secondary outcome was the cost per seizure avoided. Robustness of the results was tested with univariate and probabilistic sensitivity analyses. RESULTS The lacosamide treatment pathway was associated with higher costs (i.e. €1,064) and an additional 0.119 QALYs when compared with zonisamide, resulting in an incremental cost-effectiveness ratio of €8,938 per QALY gained. The sensitivity analyses demonstrated that the results are most sensitive to the efficacy and utility estimates. LIMITATIONS There are a number of limitations which stem from the process of model adaptation and lack of local real-world evidence. CONCLUSIONS Lacosamide is a cost-effective option at a willingness-to-pay threshold of €30,000 per QALY, representing a valuable monotherapy treatment option for patients with focal epileptic seizures in the Greek setting.
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Affiliation(s)
- Mary Geitona
- a School of Social & Political Sciences, Department of Social & Educational Policy , University of Peloponnese , Corinth , Greece
| | - Eugena Stamuli
- b Research Fellow Department of Health Sciences , University of York , York , UK
| | | | - Vasileios K Kimiskidis
- d Laboratory of Clinical Neurophysiology , AHEPA University Hospital, Aristotle University of Thessaloniki , Thessaloniki , Greece
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Ákos Szabó C, Morgan LC, Sonnenberg S, Karkar KM. Absence status induced by lacosamide adjunctive therapy. Epileptic Disord 2019; 21:97-101. [PMID: 30782579 DOI: 10.1684/epd.2019.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Since lacosamide was approved as an adjuvant agent for the treatment of medically refractory focal epilepsy over ten years ago, it is becoming more widely used for the treatment of idiopathic (genetic) generalized epilepsies. Several studies have demonstrated efficacy in reducing primary generalized tonic-clonic seizures (GTCS), but efficacy is less well-characterized for myoclonic and absence seizures. A 29-year-old man with juvenile myoclonic epilepsy and medically refractory GTCS on a combination of levetiracetam and topiramate was started on lacosamide adjunctive therapy with the plan to replace topiramate. While his GTCS became controlled, he was witnessed to have confusional episodes, with waxing and waning responsiveness, lasting a few days, several times a month. After eight months of adjunctive lacosamide therapy, he was admitted to the epilepsy monitoring unit, where paroxysms of generalized spike-and-wave complexes, lasting for 30-90 minutes, were recorded, interrupted only by sleep. During these periods, he demonstrated psychomotor slowing and disorientation on examination. The absence status was successfully broken by lorazepam, and lacosamide was discontinued. The patient had no further confusional episodes at the most recent follow-up visit, four months after discharge.
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Affiliation(s)
- Charles Ákos Szabó
- Department of Neurology and South Texas Comprehensive Epilepsy Center, UT Health San Antonio, San Antonio, Texas
| | - Lola C Morgan
- Department of Neurology and South Texas Comprehensive Epilepsy Center, UT Health San Antonio, San Antonio, Texas
| | - Suzanne Sonnenberg
- Department of Neurology and South Texas Comprehensive Epilepsy Center, UT Health San Antonio, San Antonio, Texas
| | - Kameel M Karkar
- Department of Neurology and South Texas Comprehensive Epilepsy Center, UT Health San Antonio, San Antonio, Texas
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