title: Seizure freedom is not adversely affected by early discontinuation of concomitant anti-epileptic drugs in the EULEV cohort of levetiracetam users.
abstract: OBJECTIVE
  Fear of discontinuing concomitant anti-epileptic drugs (AEDs) may lead to potentially unnecessary and perhaps unsafe polypharmacy. The effect of withdrawing concomitant AEDs on epilepsy control was therefore studied in long-term users of levetiracetam.
  
  
  METHODS
  The EULEV cohort followed patients initiating levetiracetam in France in 2005 or 2006 for one year. In those maintaining levetiracetam throughout the study period, the association of a reduction in the number of concomitant AEDs during the first six months with seizure-freedom during the last six months of follow-up was investigated using logistic regression.
  
  
  RESULTS
  Of the 356 patients continuing levetiracetam for at least 1 year, 140 (39.3%) were seizure-free during the last six months of follow-up. Partial symptomatic or generalised idiopathic epilepsy were associated with greater seizure-freedom than partial cryptogenic disease. Factors associated with seizures were: longer disease duration, initial incapacity, increased number of seizures in the six months preceding levetiracetam initiation, and number of consultations for epilepsy in the six months preceding levetiracetam initiation. There was a trend for the association between the early reduction in the number of concomitant AEDs and seizure-free status later during follow-up, which however did not reach statistical significance in the final propensity score-adjusted multivariate model (OR = 1.8, 95%CI [0.8;4.0]).
  
  
  CONCLUSIONS
  Taking into account the various risk factors for seizures, the early reduction of concomitant AEDs was not associated with worse seizure rates during follow-up in real-life users of levetiracetam.
authors.affiliation: INSERM, CIC-P0005, Bordeaux, France. cecile.droz@pharmaco.u-bordeaux2.fr
authors.forename: Cécile
authors.initials: C
authors.lastname: Droz-Perroteau
authors.forename: Cécile
authors.initials: C
authors.lastname: Marchal
authors.forename: Caroline
authors.initials: C
authors.lastname: Dureau-Pournin
authors.forename: Régis
authors.initials: R
authors.lastname: Lassalle
authors.forename: Jérémy
authors.initials: J
authors.lastname: Jové
authors.forename: Philip
authors.initials: P
authors.lastname: Robinson
authors.forename: Gilles
authors.initials: G
authors.lastname: Lavernhe
authors.forename: Hervé
authors.initials: H
authors.lastname: Vespignani
authors.forename: Nicholas
authors.initials: N
authors.lastname: Moore
authors.forename: Annie
authors.initials: A
authors.lastname: Fourrier-Réglat
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D000077287:Levetiracetam; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017891:Pharmacoepidemiology; D010889:Piracetam / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D057216:Propensity Score; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D028761:Withholding Treatment / Q000706:statistics & numerical data
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D010889:Piracetam