Dr Tomohiro YamazoeTomohiro Yamazoe, MD, PhD
In a recent retrospective study of patients with epilepsy, lacosamide (Vimpat, UCB Pharma) demonstrated an excellent drug profile, providing patients with high rates of seizure freedom and response as both an add-on treatment and monotherapy.1

The data were presented at the 2019 International Epilepsy Congress, June 22-26, in Bangkok, Thailand. 

Additionally, those treated with the selective sodium-channel slow inactivation enhancer had fewer adverse events (AEs) than those treated with other antiepileptic therapies such as levetiracetam, carbamazepine, and clobazam.

“[Lacosamide] could be used as one of the first line medications for patients with epilepsy,” lead author Tomohiro Yamazoe, MD, PhD, department of neurosurgery, Seirei Hamamatsu General Hospital, and colleagues wrote.

In Japan, where the study was conducted, the therapy is approved for the treatment of focal onset seizures with or without secondary generalization as monotherapy and adjunctive therapy in patients aged 4 years and older. In the United States, it was originally approved for use in 2008, and can be prescribed either alone or with other seizure medicines to treat focal seizures in adults and children 4 years of age or older in tablet form. As well, it has an injection formulation for focal seizures in those 17 years and older, for temporary use when an individual is unable to take an oral form of the treatment.

“[Lacosamide] is one of the third-generation antiepileptic drugs and used more frequently in early add-on or monotherapy,” the investigators wrote. “It is meaningful to investigate its efficacy and usefulness in daily practice of the real world.”

The study examined medical records of 87 patients with epilepsy at 3 acute care centers, all of which had daily seizure frequency recordings and were prescribed lacosamide. Of the total cohort, 81.6% (n = 71) had symptomatic localization-related epilepsy, while the remaining 18.4% (n = 16) had generalized epilepsy.

Seizure events were found to be occurring daily prior to treatment with lacosamide for 28% of patients, weekly in 30.5%, and monthly in 22%. At the start of lacosamide administration, the mean number of concomitant antiepileptic drugs was 1.9, with the aforementioned levetiracetam, carbamazepine, and clobazam being the 3 major simultaneously prescribed therapies. By the end of the trial period, the use of concomitant therapy with lacosamide was reduced, with the mean dropping to 1.6 by the end of the study period.

In total, 87.3% (n = 76) of the cohort continued on lacosamide, and 51.7% (n = 45) obtained seizure freedom while on the UCB-manufactured agent. Seizure freedom was higher, at 88.9%, for those who were taking it as monotherapy. The responder rate, defined as a ≥50% reduction in seizures, was 69%.

The majority of adverse events (AEs) were considered transient and did not require additional treatment. All told, 6.9% (n = 6) of patients reported dizziness, while 4.6% (n = 4) reported solemnence.

After the American Epilepsy Society’s 2018 annual meeting, Trevor Resnick, MD, of Nicklaus Children’s Hospital, discussed the low-risk and high-risk populations of patients whose seizures are likely to be controlled by medication. In that conversation, Resnick told NeurologyLive® that the agent “is a very well-tolerated drug that is effective for partial-onset seizures and partial complex seizures. And I see it as a very good addition in patients with partial complex seizures, even as first-line therapy, because of the fact that it’s very well tolerated.”

As is the case with the majority of seizure medications which are currently FDA approved, the mechanism of the antiseizure effect of lacosamide is not completely comprehended. The belief is that believed that it enhances sodium channel slow inactivation, as mentioned previously, and thus should have a similar but distinct mechanism to other seizure treatments, such as phenytoin or carbamazepine.2

For more IEC 2019 coverage, click here.
REFERENCES
1. Yamazoe T, Yamamoto T, Ando N, et al. Efficacy and usefulness of lacosamide in early add-on and monotherapy for patients with epilepsy. Presented at: IEC 2019; June 22 to 26, 2019; Bangkok, Thailand. Poster 131.
2. Lacosamide. Epilepsy Foundation website. Updated 2019. epilepsy.com/medications/lacosamide/advanced. Accessed June 22, 2019.