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Comparative Study
. 2024 Oct;65(10):2897-2908.
doi: 10.1111/epi.18087. Epub 2024 Aug 10.

Lamotrigine vs levetiracetam in female patients of childbearing age with juvenile absence epilepsy: A Bayesian reanalysis

Emanuele Cerulli Irelli  1 , Enrico Cocchi  2   3 , Joanna Gesche  4   5 , Javier Peña-Ceballos  6 , Roberto H Caraballo  7 , Simona Lattanzi  8 , Gionata Strigaro  9 , Biagio Orlando  1 , Patrick B Moloney  6 , Cecilia Catania  1 , Edoardo Ferlazzo  10   11 , Angelo Pascarella  10   11 , Sara Casciato  12 , Chiara Pizzanelli  13 , Chiara Milano  13 , Loretta Giuliano  14 , Veronica Viola  15 , Barbara Mostacci  15 , Francesco Fortunato  16 , Patrizia Pulitano  1 , Eleonora Rosati  17 , Marco Perulli  18 , Norman Delanty  6   19   20 , Giancarlo Di Gennaro  21 , Antonio Gambardella  16 , Angelo Labate  22 , Francesca F Operto  23 , Anna T Giallonardo  1 , Betul Baykan  24   25 , Christoph P Beier  4   5 ; Women with Epilepsy Treatment Options and Research (WETOR) study group; Carlo Di Bonaventura  1
Affiliations
Comparative Study

Lamotrigine vs levetiracetam in female patients of childbearing age with juvenile absence epilepsy: A Bayesian reanalysis

Emanuele Cerulli Irelli et al. Epilepsia. 2024 Oct.

Abstract

Objective: Women of childbearing age with juvenile absence epilepsy (JAE) face treatment challenges due to limited access to safe and effective anti-seizure medications (ASMs). In a previous study we compared the effectiveness of levetiracetam (LEV) and lamotrigine (LTG) in women with idiopathic generalized epilepsy (IGE), highlighting a superiority of LEV in juvenile myoclonic epilepsy. In this study, we specifically reanalyzed, through a Bayesian approach and by expanding the previously published cohort, the comparative effectiveness of these ASMs as initial monotherapy in JAE.

Methods: We conducted a multicenter, retrospective, comparative effectiveness study on women of childbearing age diagnosed with JAE and prescribed LEV or LTG as the initial ASM. Inverse probability treatment weighting (IPTW) Bayesian Cox proportional hazard models were employed to evaluate treatment failure (TF) due to ineffectiveness and ASM retention. The patients' center of provenance and year of prescription were considered as random effect factors. Posterior probabilities and relative log-risk distribution were computed, and the distribution of posterior draws was analyzed to assess the evidence supporting LTG superiority over LEV.

Results: Of 123 patients, those treated with LTG (n = 67) demonstrated lower TF and higher ASM retention than those treated with LEV (n = 56), with the IPTW-weighted Bayesian Cox proportional hazards model showing a 99.2% posterior probability of LTG being superior on TF and a 99.5% probability on ASM retention. Additional analyses on ≥50% and ≥75% seizure reduction through IPTW-weighted Bayesian logistic regression largely confirmed these findings, whereas the two ASMs did not show evident differences in terms of seizure freedom. The two ASMs showed comparable safety profiles, with only a minority of patients discontinuing treatment due to side effects.

Significance: Bayesian reanalysis supports LTG as first-line monotherapy for JAE in women of childbearing age, emphasizing the importance of individualized treatment strategies in women with IGE. This study underscores the value of Bayesian methods in refining clinical research and treatment decisions.

Keywords: anti‐seizure medication (ASM); first‐line; idiopathic generalized epilepsy (IGE); monotherapy; women.

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References

REFERENCES

    1. Chu H, Zhang X, Shi J, Zhou Z, Yang X. Antiseizure medications for idiopathic generalized epilepsies: a systematic review and network meta‐analysis. J Neurol. 2023;270(10):4713–4728. https://doi.org/10.1007/s00415‐023‐11834‐8
    1. Battino D, Tomson T, Bonizzoni E, Craig J, Perucca E, Sabers A, et al. Risk of major congenital malformations and exposure to antiseizure medication monotherapy. JAMA Neurol. 2024;81:481–489. https://doi.org/10.1001/jamaneurol.2024.0258
    1. Marson A, Burnside G, Appleton R, Smith D, Leach JP, Sills G, et al. The SANAD II study of the effectiveness and cost‐effectiveness of valproate versus levetiracetam for newly diagnosed generalised and unclassifiable epilepsy: an open‐label, non‐inferiority, multicentre, phase 4, randomised controlled trial [published correction appears in Lancet. 2021 Apr 24;397(10284):1544] [published correction appears in Lancet. 2021 May 15;397(10287):1808]. Lancet. 2021;397(10282):1375–1386. https://doi.org/10.1016/S0140‐6736(21)00246‐4
    1. Cerulli Irelli E, Cocchi E, Morano A, Gesche J, Caraballo RH, Lattanzi S, et al. Predictors of seizure recurrence in women with idiopathic generalized epilepsy who switch from valproate to another medication. Neurology. 2024;102(9):e209222. https://doi.org/10.1212/WNL.0000000000209222
    1. Mbizvo GK, Bucci T, Lip GYH, Marson AG. Morbidity and mortality risks associated with valproate withdrawal in young men and women with epilepsy. Brain. 2024;awae128. https://doi.org/10.1093/brain/awae128. online ahead of print.

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