Long-term efficacy, safety, and tolerability, including behavior and executive functioning, during adjunctive
Mark Kristof Farkas1, Iryna Makedonska2, Cynthia Beller3
1Pediatric Center, Semmelweis University, Bókay János u. 53-54, Budapest 1083, Hungary.
Insights
Long-term adjunctive lacosamide (LCM) is effective and well-tolerated for pediatric epilepsy, showing sustained seizure control and stable behavior. This epilepsy treatment demonstrated no worsening in executive functioning in children.
Area of Science:
- Pediatric Neurology
- Epilepsy Treatment
- Pharmacology
Background:
- Epilepsy affects a significant number of children worldwide.
- Long-term treatment options for pediatric epilepsy are crucial for managing chronic conditions.
- Assessing the impact of antiepileptic drugs on behavior and cognition is essential for pediatric patients.
Purpose of the Study:
- To evaluate the long-term efficacy, safety, and tolerability of adjunctive lacosamide (LCM) in pediatric patients with focal-onset or generalized seizures.
- To assess the effects of LCM on behavior and executive functioning in children over an extended treatment period.
Main Methods:
- Two open-label extension trials (NCT00938912, NCT01964560) involving 905 pediatric patients with epilepsy.
- Outcomes included treatment retention, seizure frequency reduction, and assessment of adverse events.
- Behavior and executive functioning were evaluated using the Achenbach Child Behavior Checklist (CBCL) and Behavior Rating Inventory of Executive Function® (BRIEF).
Main Results:
- High 1-year retention rate (80%) and significant seizure frequency reduction (median 60.4%) in focal-onset seizures.
- Over 75% of patients showed improvement as per physician and caregiver global impression scales.
- Treatment-emergent adverse events were common (82.8%), with pyrexia and upper respiratory tract infections being most frequent; behavioral and executive functions remained stable or improved.
Conclusions:
- Long-term adjunctive lacosamide (LCM) is efficacious and generally well-tolerated in children with focal-onset or generalized seizures.
- Adjunctive LCM treatment did not result in observable worsening of behavior or executive functioning in pediatric epilepsy patients.
- The study supports the use of LCM as a long-term therapeutic option for pediatric epilepsy.
Objectives:
To evaluate long-term efficacy, safety, and tolerability, including behavior and executive functioning, during adjunctive lacosamide (LCM) treatment in pediatric patients (≥1 month to <18 years of age) with focal-onset or generalized seizures enrolled in 2 open-label, long-term follow-up trials.
Methods:
Two open-label extension trials (SP848: NCT00938912; EP0034: NCT01964560) were conducted in pediatric patients who had participated in previous trials of adjunctive LCM (SP0847/NCT00938431; SP0966/NCT01969851; EP0060/NCT02710890; SP0967/NCT02477839; SP0969/NCT01921205); SP848 also directly enrolled eligible pediatric patients who had not previously participated in a clinical trial of LCM. Outcomes included retention, efficacy, and safety/tolerability. Patient improvement was assessed with Clinician's and Caregiver's Global Impression of Change scale. Behavior and emotional function was assessed with Achenbach Child Behavior Checklist (CBCL) and executive functioning was assessed with Behavior Rating Inventory of Executive Function® (BRIEF).
Results:
The pooled dataset from both trials included 905 patients (851 in the focal-onset seizure population and 47 in the generalized seizure population). In the overall population, Kaplan-Meier-estimated 1-year retention was 80 %. From baseline to the end of the treatment period, patients in the focal-onset seizure population had a median percent reduction in focal-onset seizure frequency per 28 days of 60.4 %, 55.4 % of patients were 50 % responders, and 40.8 % of patients were 75 % responders. In patients with ≥12 months of LCM treatment, ≥12 month seizure freedom during the LCM treatment period was achieved by 29.9 % of patients in the focal-onset seizure population (median duration of first ≥12-month seizure-free interval: 641 days) and 24.4 % of patients in the generalized seizure population (median duration of first ≥12-month seizure-free interval: 665 days). Improvement during LCM treatment was reported in >75 % of patients by both physicians and caregivers. Treatment-emergent adverse events (TEAEs) were reported by 749 (82.8 %) patients, most commonly pyrexia (18.9 %), upper respiratory tract infection (18.6 %), nasopharyngitis (16.2 %), vomiting (15.7 %), and somnolence (11.8 %). The most common drug-related TEAEs were somnolence (8.5 %), dizziness (7.6 %), and vomiting (5.4 %). Behavioral and emotional function was generally stable in patients 1.5-5 years of age and slightly improved in patients ≥6 years of age, and executive functioning was stable in patients <5 years of age and generally slightly improved in patients 5-18 years of age.
Conclusions:
In this analysis of a large patient pool from 2 open-label trials, long-term adjunctive LCM was efficacious and generally well tolerated in children with epilepsy and focal-onset or generalized seizures. Behavior and executive functioning were generally stable without observable worsening during long-term adjunctive LCM treatment.
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