The long-term use of gabapentin, lamotrigine, and vigabatrin in patients with chronic epilepsy.
OBJECTIVE
To compare the long-term retention of gabapentin (GBP), lamotrigine (LTG), and vigabatrin (VGB) by patients with chronic epilepsy and the reasons for treatment discontinuation. To assess the likelihood of seizure freedom, seizure-related injury/hospital admission and mortality after these drugs were commenced.


METHODS
This was a retrospective case-records survey in five tertiary referral epilepsy centres in the U.K. The retention times on treatment (from initiation to discontinuation) for the different antiepileptic drugs (AEDs) were compared by using Kaplan-Meier survival analysis and Cox regression. Incidences of seizure freedom and seizure-related injury/hospital admissions and standardised mortality ratios were calculated.


RESULTS
There were 1,375 patients with chronic epilepsy included; 361 were taking GBP, 1,050 LTG, and 713 VGB. The retention of GBP, LTG, or VGB was <40% at 6 years. Fewer than 4% of patients become seizure free while taking one of the drugs. There was no reduction in mortality or seizure-related injury/admission.


CONCLUSIONS
The impact of these new AEDs on chronic epilepsy can be described only as modest. This view may be revised, however, as more experience is gained with new drugs in previously untreated patients.
Wong
I C
IC
School of Pharmacy, University of Bradford, England, UK. i.c.k.wong@bradford.ac.uk
Chadwick
D W
DW
Fenwick
P B
PB
Mawer
G E
GE
Sander
J W
JW
D000085:Acetates / Q000627:therapeutic use*; D000553:Ambulatory Care; D000588:Amines; D000927:Anticonvulsants / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D003509:Cyclohexanecarboxylic Acids; D004334:Drug Administration Schedule; D004827:Epilepsy / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D019317:Evidence-Based Medicine; D000077206:Gabapentin; D006801:Humans; D000077213:Lamotrigine; D008137:Longitudinal Studies; D008499:Medical Records; D015337:Multicenter Studies as Topic; D010352:Patient Dropouts; D017891:Pharmacoepidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014227:Triazines / Q000627:therapeutic use*; D006113:United Kingdom; D020888:Vigabatrin / Q000627:therapeutic use*; D005680:gamma-Aminobutyric Acid
D000085:Acetates; D000588:Amines; D000927:Anticonvulsants; D003509:Cyclohexanecarboxylic Acids; D014227:Triazines; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D020888:Vigabatrin; D000077213:Lamotrigine