| Background: Epilepsy(Ep)is a common neurological disorder that has been universally recognized as being treated with long-term medications,and newer antiepileptic seizure medications(ASMs)are widely used in clinical settings for their broad spectrum of antiepileptic effects,high seizure control rates,and low side effects.They have been recognized by the International League against Epilepsy(ILAE)experts for their useful clinical references.Although there have been numerous clinical studies on their effectiveness and tolerability,further studies are needed for long-term efficacy observation.Retention rate is now a new clinical standard for assessing long-term efficacy in epilepsy,which can fully reflect the effectiveness,tolerability,and applicability of drugs,and also fully consider the subjective wishes of patients.Purpose: To compare the retention rate of the conventional ASMs carbamazepine(CBZ),valproic acid(VPA)and the new ASMs lamotrigine(LTG),oxcarbazepine(OXC),topiramate(TPM)and levetiracetam(LEV)in the first monotherapy of patients with primary diagnosis of epilepsy,and the analysis of the efficiency and safety of ASMs in epilepsy treatment,provide guidance for better,rational and standardized drug treatment for epilepsy patients.Method: We consecutively recruited newly diagnosed epilepsy patients who were outpatients and inpatients in the Department of Neurology at the Affiliated Hospital of Yangzhou University from July 2013 to June 2022,and screened 218 patients who received formal initial monotherapy with carbamazepine,valproic acid,lamotrigine,oxcarbazepine,topiramate,and levetiracetam,respectively,and were observed at 1-year follow-up with seizure frequency,side effects,and reasons for drug discontinuation and statistical analysis was performed.Retention rates were calculated for the 6 ASMs monotherapy after 3 months,6 months,and 1 year of inclusion,i.e.,number of patients who continued with the initial monotherapy/number who started the drug × 100%;time to discontinuation(cumulative retention rate)was compared between the 6 treatment groups using Kaplan-Meier survival analysis,and the effect of treatment on retention rate was assessed using Cox proportional risk models,with 1-year efficiency and seizure-free rates to assess clinical efficacy,and further analysis of reasons for discontinuation was compared using SPSS 25.0 for statistical analysis.Results: 1.Excluding cases lost to follow-up(n=12),a total of 206 cases completed the study,including 32 cases in the CBZ group,54 cases in the VPA group,27 cases in the LTG group,36 cases in the OXC group,20 cases in the TPM group,and 37 cases in the LEV group.There were 100 cases(48.5%)in females and 106 cases(51.5%)in males.The age ranged from 13-83 years,with a mean age of 41.9 ± 18.0 years.The duration of epilepsy before drug administration was 2 days-23 years.There were 92 cases(44.7%)with primary epilepsy and 114 cases(65.3%)with secondary epilepsy.Cox regression analysis showed that patients’ gender,duration of disease before medication,type of attack,and etiology were not major risk factors for retention(P > 0.05);age was significantly correlated with retention(P < 0.05).2.Retention rate of ASMs: at 3 months,the retention rates were 87.5% in the CBZ group,85.2% in the VPA group,88.9% in the LTG group,86.1% in the OXC group,85.0%in the TPM group,and 91.9% in the LEV group,with no statistical difference between the 6 groups(P > 0.05).at 6 months,the retention rates were 75.0% in the CBZ group,70.4% in the VPA group 81.5% in the LTG group,72.2% in the OXC group,75.0% in the TPM group,and 83.8% in the LEV group,with no statistical difference between the 6groups for comparison(P > 0.05).at 1 year,the retention rates were 62.5% in the CBZ group,59.3% in the VPA group,70.4% in the LTG group,61.1% in the OXC group,70.0%in the TPM group,and 73.0% in the LEV group,with no statistical difference between the 6 The differences between the six groups were not significant(P > 0.05).At the end of the observation,the cumulative retention rate using Kaplan-Meier survival analysis showed similar findings as above.3.Efficiency rate: at 1 year,the efficiency rate of ASMs was 85.0% in the CBZ group,88.4% in the VPA group,89.5% in the LTG group,86.4% in the OXC group,85.7% in the TPM group,and 92.6% in the LEV group,with no significant difference between the6 groups(P > 0.05).4.Reasons for discontinuation: The main reason for discontinuation of ASMs was treatment ineffectiveness,with treatment ineffectiveness accounting for 50.0% of the reasons for discontinuation in the carbamazepine group,40.9% in the valproic acid group,50.0% in the lamotrigine group,42.9% in the oxcarbazepine group,50.0% in the topiramate group,and 40.0% in the levetiracetam group,with no significant difference between the groups(P > 0.05);the next reason was adverse effects,33.3% in the CBZ group,22.7% in the VPA group,25.0% in the LTG group,21.4% in the OXC group,33.3%in the TPM group,and 30.0% in the LEV group;other reasons for discontinuation also included poor compliance and economic reasons.5.Side effects leading to discontinuation: the most common side effect leading to discontinuation in the CBZ group was rash,followed by central nervous system symptoms(ataxia)and white blood cell drop;the most common side effect leading to discontinuation in the VPA group was abnormal liver function,and the rest were central nervous system symptoms(tremor),nausea and vomiting,weight gain and menstrual disorders;the side effects leading to discontinuation in the LTG group were rash and abnormal liver function The most common side effects leading to discontinuation in the OXC group were rash,CNS symptoms(ataxia)and nausea;in the TPM group were urinary stones and absence of sweating;in the LEV group,the most common side effects leading to discontinuation were behavioral and psychiatric disorders(irritability,aggressive behavior),and the rest were common CNS symptoms such as dizziness and headache.6.The mean daily dose of each ASMs was lower in the retention group than in the discontinuation group at 1 year,and there was a significant difference between the 6groups(P < 0.05).Conclusions: 1.The retention rate of monotherapy for the 6 ASMs showed a decreasing trend over 1 year;the retention rate and tolerability of single drugs for the 6 ASMs were similar.2.The main factor affecting the retention rate of ASMs was poor efficacy,followed by side effects.3.The higher the mean daily dose of ASMs the more likely the epilepsy patients were to discontinue. |
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