title: Long-term effect of antiepileptic drug switch on serum lipids and C-reactive protein.
abstract: Prior studies have shown that switching patients from inducing antiepileptic drugs (AEDs) to lamotrigine, levetiracetam, or topiramate reduces serum lipids and C-reactive protein (CRP). These studies were all of short duration, and some drugs, such as zonisamide, have not been investigated.
  
  
  
  We recruited 41 patients taking phenytoin or carbamazepine who were being switched to zonisamide, lamotrigine, or levetiracetam. We measured serum lipids and CRP before the switch, >6weeks after, and >6months after. An untreated control group (n=14) underwent similar measurement. We combined these data with those of our previous investigation (n=34 patients and 16 controls) of a very similar design.
  
  
  
  There were no differences in outcome measures between the two inducing AEDs nor among the three noninducing AEDs. Total cholesterol (TC), atherogenic lipids, and CRP were higher under inducer treatment than in controls. All measures were elevated under inducer treatment relative to noninducer treatment, including TC (24mg/dL higher, 95% CI: 17.5-29.9, p<0.001) and CRP (72% higher, 95% CI: 41%-111%, p<0.001). The difference between drug treatments was clinically meaningful for atherogenic lipids (16%, 95% CI: 11%-20%, p<0.001) but small for high-density lipoprotein cholesterol (5%, 95% CI: 1%-9%, p<0.05). All measures were stable between 6weeks and 6months after drug switch.
  
  
  
  We demonstrate that switching from inducing to noninducing AEDs produces an enduring reduction in serum lipids and CRP. These results provide further evidence that inducing AEDs may be associated with elevated vascular disease risk. These are the first vascular risk marker data in patients taking zonisamide, which shows a profile similar to that of other noninducing AEDs.
authors.affiliation: Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States. Electronic address: scott.mintzer@jefferson.edu.
authors.forename: Scott
authors.initials: S
authors.lastname: Mintzer
authors.affiliation: Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States.
authors.forename: Rachael
authors.initials: R
authors.lastname: Miller
authors.affiliation: Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States.
authors.forename: Krunal
authors.initials: K
authors.lastname: Shah
authors.affiliation: Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, United States.
authors.forename: Inna
authors.initials: I
authors.lastname: Chervoneva
authors.affiliation: Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States.
authors.forename: Maromi
authors.initials: M
authors.lastname: Nei
authors.affiliation: Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States.
authors.forename: Christopher
authors.initials: C
authors.lastname: Skidmore
authors.affiliation: Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Sperling
mesh_terms: D000927:Anticonvulsants / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000037:antagonists & inhibitors / Q000378:metabolism*; D002220:Carbamazepine / Q000008:administration & dosage; D057915:Drug Substitution / Q000379:methods*; D004359:Drug Therapy, Combination; D004828:Epilepsies, Partial / Q000097:blood* / Q000188:drug therapy*; D005260:Female; D005632:Fructose / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D007555:Isoxazoles / Q000008:administration & dosage; D000077213:Lamotrigine; D000077287:Levetiracetam; D008055:Lipids / Q000037:antagonists & inhibitors / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010672:Phenytoin / Q000008:administration & dosage; D010889:Piracetam / Q000008:administration & dosage / Q000031:analogs & derivatives; D013997:Time Factors; D000077236:Topiramate; D016896:Treatment Outcome; D014227:Triazines / Q000008:administration & dosage; D000078305:Zonisamide
chemical_list: D000927:Anticonvulsants; D015415:Biomarkers; D007555:Isoxazoles; D008055:Lipids; D014227:Triazines; D000077236:Topiramate; D005632:Fructose; D002220:Carbamazepine; D000077287:Levetiracetam; D000078305:Zonisamide; D010672:Phenytoin; D002097:C-Reactive Protein; D000077213:Lamotrigine; D010889:Piracetam
keywords: Antiepileptic drugs; C-reactive protein; Lipids; Vascular disease