Antiepileptic drug discontinuation by people with epilepsy in the general population

Giorgia Giussani, Elisa Bianchi, Valentina Canelli, Giuseppe Erba, Carlotta Franchi, Alessandro Nobili, Josemir W Sander, Ettore Beghi, EPIRES Group

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: Rate, reasons, and predictors of antiepileptic drug (AED) discontinuation were investigated in a well-defined cohort of people with epilepsy to verify efficacy and tolerability of treatment up to 20 years from treatment initiation.

METHODS: The history of AED usage in children and adults with epilepsy registered with 123 family physicians in an area of Northern Italy between 2000 and 2008 was recorded. Cumulative probabilities of AED withdrawal for specific reasons were estimated using cumulative incidence functions. The probabilities of withdrawing for terminal remission, and of achieving sustained remission while still on treatment, were also evaluated. The roles of sex, age at diagnosis, seizure types, duration at diagnosis, and syndrome were assessed with hazard ratios and 95% confidence intervals.

RESULTS: Seven hundred thirty-one of 747 individuals were treated with one or more AEDs during the disease course. The three commonest drugs were valproate, carbamazepine, and phenobarbital. Reported reasons for AED withdrawal were, in decreasing order, terminal remission, ineffectiveness, and adverse events. The probability of withdrawing the first AED for terminal remission was 1.0% at 1 year and increased to 20.0% at 20 years. Corresponding rates were 2.9% and 12.6% for ineffectiveness and 0.5% and 3.3% for adverse events. Reasons for withdrawal varied with individuals' age, sex, disease characteristics, and drugs.

SIGNIFICANCE: The initial AED given was retained in the majority of cases. Terminal remission, lack of efficacy, and adverse effects were, in decreasing order, the commonest reasons for AED discontinuation. Withdrawal could be predicted by age at diagnosis, sex, and clinical characteristics and varies among drugs.

Original languageEnglish
Pages (from-to)1524-1532
Number of pages9
JournalEpilepsia
Volume58
Issue number9
DOIs
Publication statusPublished - Sep 2017

Fingerprint

Anticonvulsants
Epilepsy
Population
Sex Characteristics
Pharmaceutical Preparations
Carbamazepine
Family Physicians
Valproic Acid
Phenobarbital
Italy
Seizures
History
Confidence Intervals
Incidence
Therapeutics

Keywords

  • Adolescent
  • Adult
  • Aged
  • Anticonvulsants
  • Epilepsy
  • Female
  • Humans
  • Male
  • Medication Adherence
  • Middle Aged
  • Remission Induction
  • Treatment Outcome
  • Young Adult
  • Journal Article
  • Research Support, Non-U.S. Gov't

Cite this

Giussani, G., Bianchi, E., Canelli, V., Erba, G., Franchi, C., Nobili, A., ... EPIRES Group (2017). Antiepileptic drug discontinuation by people with epilepsy in the general population. Epilepsia, 58(9), 1524-1532. https://doi.org/10.1111/epi.13853

Antiepileptic drug discontinuation by people with epilepsy in the general population. / Giussani, Giorgia; Bianchi, Elisa; Canelli, Valentina; Erba, Giuseppe; Franchi, Carlotta; Nobili, Alessandro; Sander, Josemir W; Beghi, Ettore; EPIRES Group.

In: Epilepsia, Vol. 58, No. 9, 09.2017, p. 1524-1532.

Research output: Contribution to journalArticle

Giussani, G, Bianchi, E, Canelli, V, Erba, G, Franchi, C, Nobili, A, Sander, JW, Beghi, E & EPIRES Group 2017, 'Antiepileptic drug discontinuation by people with epilepsy in the general population', Epilepsia, vol. 58, no. 9, pp. 1524-1532. https://doi.org/10.1111/epi.13853
Giussani, Giorgia ; Bianchi, Elisa ; Canelli, Valentina ; Erba, Giuseppe ; Franchi, Carlotta ; Nobili, Alessandro ; Sander, Josemir W ; Beghi, Ettore ; EPIRES Group. / Antiepileptic drug discontinuation by people with epilepsy in the general population. In: Epilepsia. 2017 ; Vol. 58, No. 9. pp. 1524-1532.
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AU - Franchi, Carlotta

AU - Nobili, Alessandro

AU - Sander, Josemir W

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N2 - OBJECTIVE: Rate, reasons, and predictors of antiepileptic drug (AED) discontinuation were investigated in a well-defined cohort of people with epilepsy to verify efficacy and tolerability of treatment up to 20 years from treatment initiation.METHODS: The history of AED usage in children and adults with epilepsy registered with 123 family physicians in an area of Northern Italy between 2000 and 2008 was recorded. Cumulative probabilities of AED withdrawal for specific reasons were estimated using cumulative incidence functions. The probabilities of withdrawing for terminal remission, and of achieving sustained remission while still on treatment, were also evaluated. The roles of sex, age at diagnosis, seizure types, duration at diagnosis, and syndrome were assessed with hazard ratios and 95% confidence intervals.RESULTS: Seven hundred thirty-one of 747 individuals were treated with one or more AEDs during the disease course. The three commonest drugs were valproate, carbamazepine, and phenobarbital. Reported reasons for AED withdrawal were, in decreasing order, terminal remission, ineffectiveness, and adverse events. The probability of withdrawing the first AED for terminal remission was 1.0% at 1 year and increased to 20.0% at 20 years. Corresponding rates were 2.9% and 12.6% for ineffectiveness and 0.5% and 3.3% for adverse events. Reasons for withdrawal varied with individuals' age, sex, disease characteristics, and drugs.SIGNIFICANCE: The initial AED given was retained in the majority of cases. Terminal remission, lack of efficacy, and adverse effects were, in decreasing order, the commonest reasons for AED discontinuation. Withdrawal could be predicted by age at diagnosis, sex, and clinical characteristics and varies among drugs.

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KW - Treatment Outcome

KW - Young Adult

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

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SP - 1524

EP - 1532

JO - Epilepsia

JF - Epilepsia

SN - 0013-9580

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