Product information and disease description Place of product in therapy Approaches to treatment

Heterogeneity of treatment effect

9 evidence topics · 11 sources

Pretreatment seizure burden and early response as predictors

“Patients who have many seizures before therapy or who have an inadequate response to initial treatment with antiepileptic drugs are likely to have refractory epilepsy.” (opens the source at this quote in a new tab)
“The prevalence of persistent seizures was higher in patients with symptomatic or cryptogenic epilepsy than in those with idiopathic epilepsy (40 percent vs. 26 percent, P=0.004) and in patients who had had more than 20 seizures before starting treatment than in those who had had fewer (51 percent vs. 29 percent, P<0.001).” (opens the source at this quote in a new tab)

Quantified effect of baseline seizure frequency and prior treatment failure

“For each increase in the numbers of seizures in the year prior to treatment, there was a 6% decrease in likelihood of being seizure free at the last clinic visit.” (opens the source at this quote in a new tab)
“Epilepsy that was not successfully controlled with the first AED had 1.73 times greater odds of not responding to treatment for each subsequent medication regimen” (opens the source at this quote in a new tab)

Course patterns and their predictability in newly diagnosed epilepsy

“Most patients with newly diagnosed epilepsy had a constant course which could usually be predicted early. The chance of seizure freedom declined with successive drug regimens, most markedly from the first to the third and among patients with localization-related epilepsies.” (opens the source at this quote in a new tab)
“Outcome pattern A was observed in 408 (37%), pattern B in 246 (22%), pattern C in 172 (16%), and pattern D in 272 (25%) patients.” (opens the source at this quote in a new tab)
“This pattern of response was particularly impressive in patients with localization-related epilepsies, who should, therefore, be evaluated early for resective surgery.” (opens the source at this quote in a new tab)

Clinical predictors of pharmacoresistance

“Those reporting more than 10 seizures prior to initiation of therapy were more than twice as likely to develop refractory epilepsy.” (opens the source at this quote in a new tab)
“Univariate and multivariate logistic regression analyses demonstrated that pharmacoresistance was also associated with family history of epilepsy, previous febrile seizures, traumatic brain injury as the cause of the epilepsy, intermittent recreational drug use, and prior or current psychiatric comorbidity, particularly depression.” (opens the source at this quote in a new tab)
“Factors not predicting poorer outcome included gender, neurological deficit and mental retardation.” (opens the source at this quote in a new tab)

Structural etiology as a determinant of seizure control

“Seizure control (>1 year without seizure) was achieved in 82% of patients who had idiopathic generalized epilepsy, 35% of those with symptomatic partial epilepsy, 45% of those with cryptogenic partial epilepsy, and 11% of those with partial epilepsy associated with hippocampal sclerosis (HS).” (opens the source at this quote in a new tab)
“In partial epilepsy, HS, cerebral dysgenesis, and dual pathology (HS and another lesion) were associated with a low rate of seizure-free patients (11%, 24%, and 3%, respectively).” (opens the source at this quote in a new tab)

Pharmacogenomic predictor of carbamazepine hypersensitivity

“HLA-B*15:02 is specific for carbamazepine- and oxcarbazepine-induced SJS and TEN, though the data are strongest for carbamazepine.” (opens the source at this quote in a new tab)
“The FDA label for carbamazepine carries a boxed warning about the risk of SJS/TEN with the presence of the HLA-B*15:02 allele” (opens the source at this quote in a new tab)

Adjunctive efficacy by number of previously used antiseizure medications

“Adjunctive BRV showed efficacy and was generally well tolerated in adults with focal seizures independent of the number of previous ASMs.” (opens the source at this quote in a new tab)
“The 50% responder rate was 26.9%, 29.9%, 30.0%, and 29.7% for BRV 50, 100, 200, and 50-200 mg/day, respectively (placebo: 13.2%); odds ratios versus placebo were statistically significant (p < 0.05) for BRV 100, 200, and 50-200 mg/day.” (opens the source at this quote in a new tab)

Real-world seizure freedom by timing of adjunctive treatment

“Sustained seizure freedom was achieved by 22.4% (n = 17) of early users and 8.7% (95% CI: 5.8–12.3, n = 27) of late users” (opens the source at this quote in a new tab)

Azetukalner response by baseline disease severity

“Overall, 14.9% (n=114) in the placebo group and 54.5% (n=112) in the XEN1101 25-mg group achieved RR50. With XEN1101 treatment, RR50 was achieved by 65.5% of patients with ≤8.5 seizures per month at baseline (n=29) and 50.6% with >8.5 seizures per month (n=83), 64.2% of patients with ≤6 prior ASMs (n=67) and 40.0% with >6 ASMs (n=45), and 56.9% of patients with one to two concomitant ASMs (n=58) and 51.9% with three concomitant ASMs (n=54).” (opens the source at this quote in a new tab)
“XEN1101 was relatively more effective in patients with indicators of less-severe disease in the trial population. These findings suggest that XEN1101 may be appropriate for use in patients with focal epilepsy across the spectrum of disease severity.” (opens the source at this quote in a new tab)