title: Outcomes of sustained-release formulation of valproate and topiramate monotherapy in patients with epilepsy: a multi-centre, cohort study.
abstract: BACKGROUND
  New-generation antiepileptic drugs (AEDs) tend to replace traditional AEDs as the first-line choice for epilepsy. However, whether this change results in better outcome, especially in China, remains unknown.
  
  
  RESULTS
  Two broad spectrum AEDs, the traditional drug of sustained-release formulation of valproate (SRVPA) and the new-generation drug of topiramate, were compared in patients with epilepsy as monotherapy in this multi-centre, observational cohort study from 2000 to 2011. The primary outcome was time to treatment failure. The secondary outcomes included time to first seizure, time to 12-month remission, and time to 24-month remission. Drug tolerability was assessed. Cox proportional hazard models (95% confidence interval [CI]) were used to analyse the relative risks expressed as hazard ratios (HR). Of the 1008 recruited patients, 519 received SRVPA and 489 received topiramate. SRVPA was better than topiramate (28.3% vs. 41.5%; HR = 0.62, [95% CI 0.49-0.77]; p<0.0001) in primary outcome, and in time to first seizure (56.1% vs. 69.3%; HR = 0.73, [95% CI 0.62-0.86]; p = 0.0002). No significant difference was observed between two groups in time to 12-month remission (52.6% vs. 42.5%; HR = 1.01, [95% CI 0.84-1.23]; p = 0.88) and time to 24-month remission (34.7% vs. 25.2%; HR = 1.11, [95% CI 0.88-1.42]; p = 0.38). 36 patients (6.9%) in SRVPA group and 37 patients (7.6%) in topiramate group presented treatment failure associated with intolerable adverse events, there was no significant difference between the two groups (p = 0.70).
  
  
  CONCLUSIONS
  The SRVPA is more suitable than topiramate for Chinese epileptic patients, and our results support the viewpoint that traditional AEDs should be the first-line choice for epilepsy rather than new-generation AEDs.
authors.affiliation: Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China.
authors.forename: Yida
authors.initials: Y
authors.lastname: Hu
authors.forename: Xishun
authors.initials: X
authors.lastname: Huang
authors.forename: Dinglie
authors.initials: D
authors.lastname: Shen
authors.forename: Meiping
authors.initials: M
authors.lastname: Ding
authors.forename: Hongbin
authors.initials: H
authors.lastname: Sun
authors.forename: Bin
authors.initials: B
authors.lastname: Peng
authors.forename: Xiangshu
authors.initials: X
authors.lastname: Hu
authors.forename: Hua
authors.initials: H
authors.lastname: Li
authors.forename: Kebin
authors.initials: K
authors.lastname: Zeng
authors.forename: Zhiqin
authors.initials: Z
authors.lastname: Xi
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.forename: Qingqing
authors.initials: Q
authors.lastname: Cao
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhou
authors.forename: Mengjiao
authors.initials: M
authors.lastname: Wu
authors.forename: Yaodong
authors.initials: Y
authors.lastname: Lu
authors.forename: Guojun
authors.initials: G
authors.lastname: Chen
authors.forename: Xuefeng
authors.initials: X
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D002681:China; D015331:Cohort Studies; D004827:Epilepsy / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005632:Fructose / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D000077236:Topiramate; D016896:Treatment Outcome; D014635:Valproic Acid / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose; D014635:Valproic Acid