First-Line Antiepileptic Drug Treatment in Glioma Patients with Epilepsy
Gliomas are the most common malignant primary brain tumors
and treatment options are multimodal. Seizures are a well-recognized
symptom in glioma patients and occur frequently, either as a presenting symptom
or during the course of the disease. The incidence of seizures is higher
in slow-growing tumors.
Seizure control plays an important role in the clinical
management of gliomas and standard-of-care involves treatment with an
antiepileptic drug (AED) once a first seizure has occurred. Seizure
control can also be achieved with anti-tumor treatment, including surgical
resection, radiotherapy, and chemotherapy.
Currently, levetiracetam and valproic acid are two of the
most commonly prescribed first-line AEDs in patients with glioma.
The aim of this retrospective observational study was to
compare the effectiveness of two of the most commonly prescribed AEDs in glioma
patients with epilepsy: levetiracetam and valproic acid.
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The authors compared the use of levetiracetam versus valproic
acid as a first-line antiseizure medication in patients with glioma and
epilepsy.
With a maximum follow-up duration of 36 months, the results
showed that the cumulative incidence of treatment failure was lower with
levetiracetam compared with valproic acid.
- Levetiracetam
had better efficacy compared to valproic acid.
- Levetiracetam
and valproic acid had a similar level of toxicity.
- Levetiracetam
and valproic acid had similar overall survival.
- Seizure control was similar in low-grade (grade 2) and high-grade (grade 3 or 4) glioma patients.
These
results suggest that levetiracetam may have favorable efficacy compared to
valproic acid, whereas the level of toxicity seems similar. Therefore,
levetiracetam seems to be the preferred choice for first-line AED treatment in
patients with glioma.
This was a large head-to-head comparison of two
popular antiseizure drugs and showed that levetiracetam as a first-line
antiseizure medication had better efficacy in patients with glioma and
seizures.
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Objective
This study
aimed at estimating the cumulative incidence of antiepileptic drug (AED)
treatment failure of first-line monotherapy levetiracetam vs valproic acid in
glioma patients with epilepsy.
Methods
In this
retrospective observational study, a competing risks model was used to estimate
the cumulative incidence of treatment failure, from AED treatment initiation,
for the two AEDs with death as a competing event. Patients were matched on
baseline covariates potentially related to treatment assignment and outcomes of
interest according to the nearest neighbor propensity score matching technique.
Maximum duration of follow-up was 36 months.
Results
In total,
776 patients using levetiracetam and 659 using valproic acid were identified.
Matching resulted in two equal groups of 429 patients, with similar covariate
distribution. The cumulative incidence of treatment failure for any reason was
significantly lower for levetiracetam compared to valproic acid 12 months:
33% vs 50%. When looking at specific reasons of treatment failure, treatment
failure due to uncontrolled seizures was significantly lower for levetiracetam
compared to valproic acid 12 months: 16% vs 28%, but no differences were
found for treatment failure due to adverse effects 12 months: 14% vs 15%.
Significance
These
results suggest that levetiracetam may have favorable efficacy compared to
valproic acid, whereas level of toxicity seems similar. Therefore,
levetiracetam seems to be the preferred choice for first-line AED treatment in
patients with glioma.
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