title: Safety and tolerability of lacosamide as adjunctive therapy for adults with partial-onset seizures: Analysis of data pooled from three randomized, double-blind, placebo-controlled clinical trials.
abstract: OBJECTIVE
  The objective of this study was to describe a priori protocol-defined analyses to evaluate the safety and tolerability of adjunctive oral lacosamide (200-600 mg/day) in adults (ages 16-70 years) with partial-onset seizures (POS) using data pooled from three similarly designed randomized, double-blind, placebo-controlled trials (SP667, SP754 [NCT00136019], SP755 [NCT00220415]).
  
  
  METHODS
  Patients with POS (≥2 years' duration, ≥2 previous antiepileptic drugs [AEDs]) uncontrolled by a stable dosing regimen of 1-3 concomitant AEDs were randomized to treatment with lacosamide at doses of 200 mg/day, 400 mg/day, or 600 mg/day, or placebo. Studies comprised a 4- to 6-week titration phase to target dose followed by a 12-week maintenance phase. Safety outcomes included treatment-emergent adverse events (TEAEs) of particular relevance to patients with POS, overall TEAEs, and discontinuations due to TEAEs. Post hoc analyses included evaluation of TEAEs potentially related to cognition and TEAEs leading to discontinuation analyzed by concomitant AEDs.
  
  
  RESULTS
  One thousand three hundred eight patients were randomized to and received treatment; 944 to lacosamide and 364 to placebo. Most patients (84.4%) were taking 2 or 3 concomitant AEDs. The most common drug-associated TEAEs (reported by ≥5% of patients in any lacosamide dose group and with an incidence at least twice that reported for placebo during the treatment phase) were dizziness (30.6% for lacosamide vs 8.2% for placebo), nausea (11.4% vs 4.4%), and diplopia (10.5% vs 1.9%). Common drug-associated TEAEs generally appeared to be dose-related, and the incidence of each was lower during the 12-week maintenance phase than during the titration phase. Most TEAEs were either mild or moderate in intensity; severe TEAEs were predominantly observed with lacosamide 600 mg/day. No individual serious TEAE occurred in ≥1% of all lacosamide-treated patients. Treatment-emergent adverse events led to discontinuation in 8.1%, 17.2%, and 28.6% of the lacosamide 200-, 400-, and 600-mg/day groups, respectively (vs 4.9% of placebo). Few TEAEs were related to rash, weight loss/gain, changes in clinical chemistry parameters, or psychiatric disturbances, or were seizure-related. The odds of reporting any potential cognition-related TEAE vs placebo increased with dose and were similar between lacosamide doses of 200 and 400mg/day and placebo (odds ratio 1.3, 95% confidence interval 0.7-2.4). Discontinuations due to TEAEs based on most commonly used AEDs taken in combination with lacosamide (all doses combined) were carbamazepine (15.3% [51/334] vs 3.9% [5/129] placebo), lamotrigine (19.2% [56/291] vs 4.3% [5/117]), and levetiracetam (10.1% [28/278] vs 3.9% [4/103]).
  
  
  CONCLUSIONS
  The safety and tolerability profile of adjunctive lacosamide in this detailed evaluation was similar to that observed in the individual double-blind trials. Adjunctive lacosamide was associated with TEAEs related to the nervous system and gastrointestinal tract, predominantly during titration.
authors.affiliation: Arkansas Epilepsy Program, #2 Lile Court Suite 100, Little Rock, AR 72205, USA. Electronic address: vbiton@gmail.com.
authors.forename: Victor
authors.initials: V
authors.lastname: Biton
authors.affiliation: Department of Neurology, Epilepsy Program, Hospital Ruber Internacional, La Masó 38, 28034 Madrid, Spain. Electronic address: agnagel@ruberinternacional.es.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gil-Nagel
authors.affiliation: UCB Pharma, 8010 Arco Corporate Drive, Raleigh, NC 27617, USA. Electronic address: jouko.isojarvi@oulu.fi.
authors.forename: Jouko
authors.initials: J
authors.lastname: Isojarvi
authors.affiliation: UCB Pharma, 8010 Arco Corporate Drive, Raleigh, NC 27617, USA. Electronic address: pamela.doty@ucb.com.
authors.forename: Pamela
authors.initials: P
authors.lastname: Doty
authors.affiliation: UCB Pharma, 8010 Arco Corporate Drive, Raleigh, NC 27617, USA. Electronic address: david.hebert@ucb.com.
authors.forename: David
authors.initials: D
authors.lastname: Hebert
authors.affiliation: FE Dreifuss Comprehensive Epilepsy Program, University of Virginia, Box 800394, Charlottesville, VA 22908, USA. Electronic address: NBF2P@hscmail.mcc.virginia.edu.
authors.forename: Nathan B
authors.initials: NB
authors.lastname: Fountain
mesh_terms: D000081:Acetamides / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D001835:Body Weight; D003071:Cognition / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D003875:Drug Eruptions / Q000453:epidemiology; D004359:Drug Therapy, Combination; D004828:Epilepsies, Partial / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D000078334:Lacosamide; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000188:drug therapy* / Q000523:psychology; D013375:Substance Withdrawal Syndrome / Q000523:psychology; D055815:Young Adult
chemical_list: D000081:Acetamides; D000927:Anticonvulsants; D000078334:Lacosamide
keywords: Lacosamide; Partial-onset seizures; Safety; Tolerability