Multicentre observational study evaluating immediate and progressive switching from carbamazepine to oxcarbazepine in patients with epilepsy

Abstract

This observational study was performed to identify the clinical reasons leading physicians to opt for immediate or progressive procedures when switching patients from carbamazepine to oxcarbazepine, and to evaluate the clinical feasibility of the two procedures in a general unselected patient population. Five hundred and twenty-seven patients (aged 14 years or older, treated with carbamazepine as monotherapy or in combination therapy) were recruited at 50 Italian centres and freely assigned to immediate (n=361) or progressive (n=166) switch procedures. Vital and clinical data (including seizure frequency) were comparable in the two groups at baseline. The proportion of patients with simple partial seizures only was significantly higher in the immediate group (immediate: 33.0% vs progressive: 23.5%, p=0.0275), whereas the proportion of patients on combination therapy was slightly higher in the progressive group (immediate: 47.1 vs progressive: 55.4%, p=0.0756). At the end of the switch period, overall treatment satisfaction was greater in the immediate switch group, both in patients (p<0.002) and physicians (p<0.0005). Physicians preferred the immediate over the progressive switch procedure. The only clinical features of patients found to relate to the physician?s choice of switch procedure were simple partial seizures only (favouring the immediate switch) and, possibly, combination therapy with other anti-epileptic drugs (favouring the progressive switch). "Overnight" switching from carbamazepine to oxcarbazepine also appears feasible in most patients on polytherapy.