Antiepileptic drug discontinuation by people with epilepsy in the general population

G. Giussani, E. Bianchi, V. Canelli, G. Erba, C. Franchi, A. Nobili, J.W. Sander, E. Beghi, the EPIRES Group, E. Agostoni, L. Airoldi, F. Basso, M. Carpanelli, M. Di Stefano, A. Magnoni, O. Martinelli, A. Rigamonti, A. Salmaggi, L. Stanzani, C. VolpeN. Zanotta, C. Zucca, M. Agudio, F. Arienti, G.R. Arrigoni, G. Balestra, P. Ballabio, S.M. Balossi, M.R. Baratti, F.E. Barteselli, F. Bellani, M. Bellani, G. Bellini, P.A. Beretta, R. Beretta, M. Bergamini, A. Bertella, F. Bertolini, R. Bevilacqua, M.A. Bianchi, P. Bigiolli, G. Binda, G. Biondelli, L. Bodega, E.G. Bolis, M. Vincenzo, C. Bolla, C.A. Bonacina, M. Bonfanti, F. Borghetti, R. Brambilla, W. Brancaleone, F. Brusadelli, S. Bub, G. Caccia, M. Caglio, C.C. Rossi, D. Capra, D. Carone, G. Carì, S. Carrera, R. Cavenago, M.L. Cecchetti, B.A. Centonze, F. Cereghini, C. Cerrone, M.P. Ciappetta, B. Cogliati, O. Colombano, A. Colombo, D. Colombo, M.L. Corti, N. Cremonini, M. Crippa, R.A. Crippa, M. Crotta, S. Curto, P. Daielli, D. De Gilio, G.P. De Pascalis, E. Decet, L. Della Morte, F. Duvia, A. Favorito, R. Ferrario, L. Fezzi, A. Laura Finzi, B.U. Fiorentino, A. Fornaciari, S. Franceschetti, F. Fulconis, G. Fumagalli, M. Fumagalli, G. Galbiati, C. Andrea Galimberti, D. Gecchele, B. Ghiazza, P. Ghislanzoni, L. Gioffredi, T. Hassibi, S. Julita, G. Leone, C. Levi, G. Locatelli, A. Locati, E.G. Longhi, I. Lukacova, M.G. Manfroi, P. Manzoni, C. Marcolini, F. Minicucci, M.S. Martini, R. Masperi, S. Mayan, V. Mazzoleni, A. Menga, F. Merlini, E. Messina, M. Micheli, R. Micò, A. Millul, B. Montini, A. Palazzuolo, S.P. Panzeri, G. Passoni, L. Pensotti, M.M. Petrone, R. Pezzuto, E. Pigazzini, N. Pirovano, M. Pontiggia, R. Pozzi, C. Quadrelli, F. Rampello, M. Realini, G. Righetti, C. Ripa, S. Rivetta, A. Romeo, C. Rota, T. Rusconi, A. Santarpia, I. Santi, L. Sciani, G. Scoccimarro, E. Scopinaro, A.G. Semerano, D. Sferco, A.E. Sirtori, A. Spandri, B. Spinelli, F. Stefanoni, R. Taiana, L. Tamagnini, L. Tassi, G. Tentori, A. Teodoro, K. Tinterova, A. Tocchetti, M. Todeschini, L. Trezza, V. Valsecchi, R. Vanini, C.F. Vercelloni, A. Villella, M. Viola, P. Vismara, D.M. Zoboli

Research output: Contribution to journalArticle

10 Citations (Scopus)

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 - 2017

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

Cite this

Giussani, G., Bianchi, E., Canelli, V., Erba, G., Franchi, C., Nobili, A., ... Zoboli, D. M. (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, G.; Bianchi, E.; Canelli, V.; Erba, G.; Franchi, C.; Nobili, A.; Sander, J.W.; Beghi, E.; Group, the EPIRES; Agostoni, E.; Airoldi, L.; Basso, F.; Carpanelli, M.; Di Stefano, M.; Magnoni, A.; Martinelli, O.; Rigamonti, A.; Salmaggi, A.; Stanzani, L.; Volpe, C.; Zanotta, N.; Zucca, C.; Agudio, M.; Arienti, F.; Arrigoni, G.R.; Balestra, G.; Ballabio, P.; Balossi, S.M.; Baratti, M.R.; Barteselli, F.E.; Bellani, F.; Bellani, M.; Bellini, G.; Beretta, P.A.; Beretta, R.; Bergamini, M.; Bertella, A.; Bertolini, F.; Bevilacqua, R.; Bianchi, M.A.; Bigiolli, P.; Binda, G.; Biondelli, G.; Bodega, L.; Bolis, E.G.; Vincenzo, M.; Bolla, C.; Bonacina, C.A.; Bonfanti, M.; Borghetti, F.; Brambilla, R.; Brancaleone, W.; Brusadelli, F.; Bub, S.; Caccia, G.; Caglio, M.; Rossi, C.C.; Capra, D.; Carone, D.; Carì, G.; Carrera, S.; Cavenago, R.; Cecchetti, M.L.; Centonze, B.A.; Cereghini, F.; Cerrone, C.; Ciappetta, M.P.; Cogliati, B.; Colombano, O.; Colombo, A.; Colombo, D.; Corti, M.L.; Cremonini, N.; Crippa, M.; Crippa, R.A.; Crotta, M.; Curto, S.; Daielli, P.; De Gilio, D.; De Pascalis, G.P.; Decet, E.; Della Morte, L.; Duvia, F.; Favorito, A.; Ferrario, R.; Fezzi, L.; Laura Finzi, A.; Fiorentino, B.U.; Fornaciari, A.; Franceschetti, S.; Fulconis, F.; Fumagalli, G.; Fumagalli, M.; Galbiati, G.; Andrea Galimberti, C.; Gecchele, D.; Ghiazza, B.; Ghislanzoni, P.; Gioffredi, L.; Hassibi, T.; Julita, S.; Leone, G.; Levi, C.; Locatelli, G.; Locati, A.; Longhi, E.G.; Lukacova, I.; Manfroi, M.G.; Manzoni, P.; Marcolini, C.; Minicucci, F.; Martini, M.S.; Masperi, R.; Mayan, S.; Mazzoleni, V.; Menga, A.; Merlini, F.; Messina, E.; Micheli, M.; Micò, R.; Millul, A.; Montini, B.; Palazzuolo, A.; Panzeri, S.P.; Passoni, G.; Pensotti, L.; Petrone, M.M.; Pezzuto, R.; Pigazzini, E.; Pirovano, N.; Pontiggia, M.; Pozzi, R.; Quadrelli, C.; Rampello, F.; Realini, M.; Righetti, G.; Ripa, C.; Rivetta, S.; Romeo, A.; Rota, C.; Rusconi, T.; Santarpia, A.; Santi, I.; Sciani, L.; Scoccimarro, G.; Scopinaro, E.; Semerano, A.G.; Sferco, D.; Sirtori, A.E.; Spandri, A.; Spinelli, B.; Stefanoni, F.; Taiana, R.; Tamagnini, L.; Tassi, L.; Tentori, G.; Teodoro, A.; Tinterova, K.; Tocchetti, A.; Todeschini, M.; Trezza, L.; Valsecchi, V.; Vanini, R.; Vercelloni, C.F.; Villella, A.; Viola, M.; Vismara, P.; Zoboli, D.M.

In: Epilepsia, Vol. 58, No. 9, 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, Group, TEPIRES, Agostoni, E, Airoldi, L, Basso, F, Carpanelli, M, Di Stefano, M, Magnoni, A, Martinelli, O, Rigamonti, A, Salmaggi, A, Stanzani, L, Volpe, C, Zanotta, N, Zucca, C, Agudio, M, Arienti, F, Arrigoni, GR, Balestra, G, Ballabio, P, Balossi, SM, Baratti, MR, Barteselli, FE, Bellani, F, Bellani, M, Bellini, G, Beretta, PA, Beretta, R, Bergamini, M, Bertella, A, Bertolini, F, Bevilacqua, R, Bianchi, MA, Bigiolli, P, Binda, G, Biondelli, G, Bodega, L, Bolis, EG, Vincenzo, M, Bolla, C, Bonacina, CA, Bonfanti, M, Borghetti, F, Brambilla, R, Brancaleone, W, Brusadelli, F, Bub, S, Caccia, G, Caglio, M, Rossi, CC, Capra, D, Carone, D, Carì, G, Carrera, S, Cavenago, R, Cecchetti, ML, Centonze, BA, Cereghini, F, Cerrone, C, Ciappetta, MP, Cogliati, B, Colombano, O, Colombo, A, Colombo, D, Corti, ML, Cremonini, N, Crippa, M, Crippa, RA, Crotta, M, Curto, S, Daielli, P, De Gilio, D, De Pascalis, GP, Decet, E, Della Morte, L, Duvia, F, Favorito, A, Ferrario, R, Fezzi, L, Laura Finzi, A, Fiorentino, BU, Fornaciari, A, Franceschetti, S, Fulconis, F, Fumagalli, G, Fumagalli, M, Galbiati, G, Andrea Galimberti, C, Gecchele, D, Ghiazza, B, Ghislanzoni, P, Gioffredi, L, Hassibi, T, Julita, S, Leone, G, Levi, C, Locatelli, G, Locati, A, Longhi, EG, Lukacova, I, Manfroi, MG, Manzoni, P, Marcolini, C, Minicucci, F, Martini, MS, Masperi, R, Mayan, S, Mazzoleni, V, Menga, A, Merlini, F, Messina, E, Micheli, M, Micò, R, Millul, A, Montini, B, Palazzuolo, A, Panzeri, SP, Passoni, G, Pensotti, L, Petrone, MM, Pezzuto, R, Pigazzini, E, Pirovano, N, Pontiggia, M, Pozzi, R, Quadrelli, C, Rampello, F, Realini, M, Righetti, G, Ripa, C, Rivetta, S, Romeo, A, Rota, C, Rusconi, T, Santarpia, A, Santi, I, Sciani, L, Scoccimarro, G, Scopinaro, E, Semerano, AG, Sferco, D, Sirtori, AE, Spandri, A, Spinelli, B, Stefanoni, F, Taiana, R, Tamagnini, L, Tassi, L, Tentori, G, Teodoro, A, Tinterova, K, Tocchetti, A, Todeschini, M, Trezza, L, Valsecchi, V, Vanini, R, Vercelloni, CF, Villella, A, Viola, M, Vismara, P & Zoboli, DM 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, G. ; Bianchi, E. ; Canelli, V. ; Erba, G. ; Franchi, C. ; Nobili, A. ; Sander, J.W. ; Beghi, E. ; Group, the EPIRES ; Agostoni, E. ; Airoldi, L. ; Basso, F. ; Carpanelli, M. ; Di Stefano, M. ; Magnoni, A. ; Martinelli, O. ; Rigamonti, A. ; Salmaggi, A. ; Stanzani, L. ; Volpe, C. ; Zanotta, N. ; Zucca, C. ; Agudio, M. ; Arienti, F. ; Arrigoni, G.R. ; Balestra, G. ; Ballabio, P. ; Balossi, S.M. ; Baratti, M.R. ; Barteselli, F.E. ; Bellani, F. ; Bellani, M. ; Bellini, G. ; Beretta, P.A. ; Beretta, R. ; Bergamini, M. ; Bertella, A. ; Bertolini, F. ; Bevilacqua, R. ; Bianchi, M.A. ; Bigiolli, P. ; Binda, G. ; Biondelli, G. ; Bodega, L. ; Bolis, E.G. ; Vincenzo, M. ; Bolla, C. ; Bonacina, C.A. ; Bonfanti, M. ; Borghetti, F. ; Brambilla, R. ; Brancaleone, W. ; Brusadelli, F. ; Bub, S. ; Caccia, G. ; Caglio, M. ; Rossi, C.C. ; Capra, D. ; Carone, D. ; Carì, G. ; Carrera, S. ; Cavenago, R. ; Cecchetti, M.L. ; Centonze, B.A. ; Cereghini, F. ; Cerrone, C. ; Ciappetta, M.P. ; Cogliati, B. ; Colombano, O. ; Colombo, A. ; Colombo, D. ; Corti, M.L. ; Cremonini, N. ; Crippa, M. ; Crippa, R.A. ; Crotta, M. ; Curto, S. ; Daielli, P. ; De Gilio, D. ; De Pascalis, G.P. ; Decet, E. ; Della Morte, L. ; Duvia, F. ; Favorito, A. ; Ferrario, R. ; Fezzi, L. ; Laura Finzi, A. ; Fiorentino, B.U. ; Fornaciari, A. ; Franceschetti, S. ; Fulconis, F. ; Fumagalli, G. ; Fumagalli, M. ; Galbiati, G. ; Andrea Galimberti, C. ; Gecchele, D. ; Ghiazza, B. ; Ghislanzoni, P. ; Gioffredi, L. ; Hassibi, T. ; Julita, S. ; Leone, G. ; Levi, C. ; Locatelli, G. ; Locati, A. ; Longhi, E.G. ; Lukacova, I. ; Manfroi, M.G. ; Manzoni, P. ; Marcolini, C. ; Minicucci, F. ; Martini, M.S. ; Masperi, R. ; Mayan, S. ; Mazzoleni, V. ; Menga, A. ; Merlini, F. ; Messina, E. ; Micheli, M. ; Micò, R. ; Millul, A. ; Montini, B. ; Palazzuolo, A. ; Panzeri, S.P. ; Passoni, G. ; Pensotti, L. ; Petrone, M.M. ; Pezzuto, R. ; Pigazzini, E. ; Pirovano, N. ; Pontiggia, M. ; Pozzi, R. ; Quadrelli, C. ; Rampello, F. ; Realini, M. ; Righetti, G. ; Ripa, C. ; Rivetta, S. ; Romeo, A. ; Rota, C. ; Rusconi, T. ; Santarpia, A. ; Santi, I. ; Sciani, L. ; Scoccimarro, G. ; Scopinaro, E. ; Semerano, A.G. ; Sferco, D. ; Sirtori, A.E. ; Spandri, A. ; Spinelli, B. ; Stefanoni, F. ; Taiana, R. ; Tamagnini, L. ; Tassi, L. ; Tentori, G. ; Teodoro, A. ; Tinterova, K. ; Tocchetti, A. ; Todeschini, M. ; Trezza, L. ; Valsecchi, V. ; Vanini, R. ; Vercelloni, C.F. ; Villella, A. ; Viola, M. ; Vismara, P. ; Zoboli, D.M. / Antiepileptic drug discontinuation by people with epilepsy in the general population. In: Epilepsia. 2017 ; Vol. 58, No. 9. pp. 1524-1532.
@article{ed5e403d808649e2bd06317291d79cfe,
title = "Antiepileptic drug discontinuation by people with epilepsy in the general population",
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. Terminalremission, 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.",
author = "G. Giussani and E. Bianchi and V. Canelli and G. Erba and C. Franchi and A. Nobili and J.W. Sander and E. Beghi and Group, {the EPIRES} and E. Agostoni and L. Airoldi and F. Basso and M. Carpanelli and {Di Stefano}, M. and A. Magnoni and O. Martinelli and A. Rigamonti and A. Salmaggi and L. Stanzani and C. Volpe and N. Zanotta and C. Zucca and M. Agudio and F. Arienti and G.R. Arrigoni and G. Balestra and P. Ballabio and S.M. Balossi and M.R. Baratti and F.E. Barteselli and F. Bellani and M. Bellani and G. Bellini and P.A. Beretta and R. Beretta and M. Bergamini and A. Bertella and F. Bertolini and R. Bevilacqua and M.A. Bianchi and P. Bigiolli and G. Binda and G. Biondelli and L. Bodega and E.G. Bolis and M. Vincenzo and C. Bolla and C.A. Bonacina and M. Bonfanti and F. Borghetti and R. Brambilla and W. Brancaleone and F. Brusadelli and S. Bub and G. Caccia and M. Caglio and C.C. Rossi and D. Capra and D. Carone and G. Car{\`i} and S. Carrera and R. Cavenago and M.L. Cecchetti and B.A. Centonze and F. Cereghini and C. Cerrone and M.P. Ciappetta and B. Cogliati and O. Colombano and A. Colombo and D. Colombo and M.L. Corti and N. Cremonini and M. Crippa and R.A. Crippa and M. Crotta and S. Curto and P. Daielli and {De Gilio}, D. and {De Pascalis}, G.P. and E. Decet and {Della Morte}, L. and F. Duvia and A. Favorito and R. Ferrario and L. Fezzi and {Laura Finzi}, A. and B.U. Fiorentino and A. Fornaciari and S. Franceschetti and F. Fulconis and G. Fumagalli and M. Fumagalli and G. Galbiati and {Andrea Galimberti}, C. and D. Gecchele and B. Ghiazza and P. Ghislanzoni and L. Gioffredi and T. Hassibi and S. Julita and G. Leone and C. Levi and G. Locatelli and A. Locati and E.G. Longhi and I. Lukacova and M.G. Manfroi and P. Manzoni and C. Marcolini and F. Minicucci and M.S. Martini and R. Masperi and S. Mayan and V. Mazzoleni and A. Menga and F. Merlini and E. Messina and M. Micheli and R. Mic{\`o} and A. Millul and B. Montini and A. Palazzuolo and S.P. Panzeri and G. Passoni and L. Pensotti and M.M. Petrone and R. Pezzuto and E. Pigazzini and N. Pirovano and M. Pontiggia and R. Pozzi and C. Quadrelli and F. Rampello and M. Realini and G. Righetti and C. Ripa and S. Rivetta and A. Romeo and C. Rota and T. Rusconi and A. Santarpia and I. Santi and L. Sciani and G. Scoccimarro and E. Scopinaro and A.G. Semerano and D. Sferco and A.E. Sirtori and A. Spandri and B. Spinelli and F. Stefanoni and R. Taiana and L. Tamagnini and L. Tassi and G. Tentori and A. Teodoro and K. Tinterova and A. Tocchetti and M. Todeschini and L. Trezza and V. Valsecchi and R. Vanini and C.F. Vercelloni and A. Villella and M. Viola and P. Vismara and D.M. Zoboli",
note = "Export Date: 27 February 2018",
year = "2017",
doi = "10.1111/epi.13853",
language = "English",
volume = "58",
pages = "1524--1532",
journal = "Epilepsia",
issn = "0013-9580",
publisher = "Blackwell Publishing Inc.",
number = "9",

}

TY - JOUR

T1 - Antiepileptic drug discontinuation by people with epilepsy in the general population

AU - Giussani, G.

AU - Bianchi, E.

AU - Canelli, V.

AU - Erba, G.

AU - Franchi, C.

AU - Nobili, A.

AU - Sander, J.W.

AU - Beghi, E.

AU - Group, the EPIRES

AU - Agostoni, E.

AU - Airoldi, L.

AU - Basso, F.

AU - Carpanelli, M.

AU - Di Stefano, M.

AU - Magnoni, A.

AU - Martinelli, O.

AU - Rigamonti, A.

AU - Salmaggi, A.

AU - Stanzani, L.

AU - Volpe, C.

AU - Zanotta, N.

AU - Zucca, C.

AU - Agudio, M.

AU - Arienti, F.

AU - Arrigoni, G.R.

AU - Balestra, G.

AU - Ballabio, P.

AU - Balossi, S.M.

AU - Baratti, M.R.

AU - Barteselli, F.E.

AU - Bellani, F.

AU - Bellani, M.

AU - Bellini, G.

AU - Beretta, P.A.

AU - Beretta, R.

AU - Bergamini, M.

AU - Bertella, A.

AU - Bertolini, F.

AU - Bevilacqua, R.

AU - Bianchi, M.A.

AU - Bigiolli, P.

AU - Binda, G.

AU - Biondelli, G.

AU - Bodega, L.

AU - Bolis, E.G.

AU - Vincenzo, M.

AU - Bolla, C.

AU - Bonacina, C.A.

AU - Bonfanti, M.

AU - Borghetti, F.

AU - Brambilla, R.

AU - Brancaleone, W.

AU - Brusadelli, F.

AU - Bub, S.

AU - Caccia, G.

AU - Caglio, M.

AU - Rossi, C.C.

AU - Capra, D.

AU - Carone, D.

AU - Carì, G.

AU - Carrera, S.

AU - Cavenago, R.

AU - Cecchetti, M.L.

AU - Centonze, B.A.

AU - Cereghini, F.

AU - Cerrone, C.

AU - Ciappetta, M.P.

AU - Cogliati, B.

AU - Colombano, O.

AU - Colombo, A.

AU - Colombo, D.

AU - Corti, M.L.

AU - Cremonini, N.

AU - Crippa, M.

AU - Crippa, R.A.

AU - Crotta, M.

AU - Curto, S.

AU - Daielli, P.

AU - De Gilio, D.

AU - De Pascalis, G.P.

AU - Decet, E.

AU - Della Morte, L.

AU - Duvia, F.

AU - Favorito, A.

AU - Ferrario, R.

AU - Fezzi, L.

AU - Laura Finzi, A.

AU - Fiorentino, B.U.

AU - Fornaciari, A.

AU - Franceschetti, S.

AU - Fulconis, F.

AU - Fumagalli, G.

AU - Fumagalli, M.

AU - Galbiati, G.

AU - Andrea Galimberti, C.

AU - Gecchele, D.

AU - Ghiazza, B.

AU - Ghislanzoni, P.

AU - Gioffredi, L.

AU - Hassibi, T.

AU - Julita, S.

AU - Leone, G.

AU - Levi, C.

AU - Locatelli, G.

AU - Locati, A.

AU - Longhi, E.G.

AU - Lukacova, I.

AU - Manfroi, M.G.

AU - Manzoni, P.

AU - Marcolini, C.

AU - Minicucci, F.

AU - Martini, M.S.

AU - Masperi, R.

AU - Mayan, S.

AU - Mazzoleni, V.

AU - Menga, A.

AU - Merlini, F.

AU - Messina, E.

AU - Micheli, M.

AU - Micò, R.

AU - Millul, A.

AU - Montini, B.

AU - Palazzuolo, A.

AU - Panzeri, S.P.

AU - Passoni, G.

AU - Pensotti, L.

AU - Petrone, M.M.

AU - Pezzuto, R.

AU - Pigazzini, E.

AU - Pirovano, N.

AU - Pontiggia, M.

AU - Pozzi, R.

AU - Quadrelli, C.

AU - Rampello, F.

AU - Realini, M.

AU - Righetti, G.

AU - Ripa, C.

AU - Rivetta, S.

AU - Romeo, A.

AU - Rota, C.

AU - Rusconi, T.

AU - Santarpia, A.

AU - Santi, I.

AU - Sciani, L.

AU - Scoccimarro, G.

AU - Scopinaro, E.

AU - Semerano, A.G.

AU - Sferco, D.

AU - Sirtori, A.E.

AU - Spandri, A.

AU - Spinelli, B.

AU - Stefanoni, F.

AU - Taiana, R.

AU - Tamagnini, L.

AU - Tassi, L.

AU - Tentori, G.

AU - Teodoro, A.

AU - Tinterova, K.

AU - Tocchetti, A.

AU - Todeschini, M.

AU - Trezza, L.

AU - Valsecchi, V.

AU - Vanini, R.

AU - Vercelloni, C.F.

AU - Villella, A.

AU - Viola, M.

AU - Vismara, P.

AU - Zoboli, D.M.

N1 - Export Date: 27 February 2018

PY - 2017

Y1 - 2017

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. Terminalremission, 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.

AB - 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. Terminalremission, 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.

U2 - 10.1111/epi.13853

DO - 10.1111/epi.13853

M3 - Article

VL - 58

SP - 1524

EP - 1532

JO - Epilepsia

JF - Epilepsia

SN - 0013-9580

IS - 9

ER -