Comparison of levetiracetam and controlled-release carbamazepine in newly diagnosed epilepsy
Abstract
Objective We report the results of a prospective study of the efficacy and tolerability of levetiracetam, a new antiepileptic drug with a unique mechanism of action, in comparison with controlled-release carbamazepine as first treatment in newly diagnosed epilepsy. Methods Adults with > or =2 partial or generalized tonic-clonic seizures in the previous year were randomly assigned to levetiracetam (500 mg twice daily, n = 288) or controlled-release carbamazepine (200 mg twice daily, n = 291) in a multicenter, double-blind, noninferiority, parallel-group trial. If a seizure occurred within 26 weeks of stabilization, dosage was increased incrementally to a maximum of levetiracetam 1,500 mg twice daily or carbamazepine 600 mg twice daily. Patients achieving the primary endpoint (6-month seizure freedom) continued on treatment for a further 6-month maintenance period. Results At per-protocol analysis, 73.0% (56.6%) of patients randomized to levetiracetam and 72.8% (58.5%) receiving controlled-release carbamazepine were seizure free at the last evaluated dose (adjusted absolute difference 0.2%, 95% CI -7.8% to 8.2%) for > or =6 months (1 year). Of all patients achieving 6-month (1-year) remission, 80.1% (86.0%) in the levetiracetam group and 85.4% (89.3%) in the carbamazepine group did so at the lowest dose level. Withdrawal rates for adverse events were 14.4% with levetiracetam and 19.2% with carbamazepine. Conclusions Levetiracetam and controlled-release carbamazepine produced eq…
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Levetiracetam has evidence of efficacy as monotherapy in patients with focal epilepsy based on non-inferiority compared with carbamazepine for 6-month seizure remission and similar tolerability in a regulatory trial.
“Levetiracetam is a commonly prescribed anti-seizure medication with evidence of efficacy as monotherapy in patients with focal epilepsy based on finding non-inferiority compared with carbamazepine for 6-month seizure remission and similar tolerability in a regulatory trial11”
Cites
Early Identification of Refractory Epilepsy
Kwan, P., & Brodie, M. J. (2000) · New England Journal of Medicine · doi:10.1056/nejm200002033420503 · Cited by 5,204 · see citing works
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Marson, A., Burnside, G., Appleton, R., Smith, D., Leach, J. P., Sills, G., Tudur-Smith, C., Plumpton, C., Hughes, D. A., Williamson, P., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(21)00247-6 · Cited by 208 · see citing works
Levetiracetam and brivaracetam: A review of evidence from clinical trials and clinical experience
Steinhoff, B. J., & Staack, A. M. (2019) · Therapeutic Advances in Neurological Disorders · doi:10.1177/1756286419873518 · Cited by 99 · see citing works
Wu, P.-P., Cao, B.-R., Tian, F.-Y., & Gao, Z.-B. (2024) · Neuroscience Bulletin · doi:10.1007/s12264-023-01138-2 · Cited by 35 · see citing works
- Authors
- Brodie, M. J., Perucca, E., Ryvlin, P., Ben-Menachem, E., & Meencke, H.-J.
- Affiliations
- University of Pavia (IT)
- From the Epilepsy Unit, Western Infirmary, Glasgow, Scotland (M.J.B.); Institute of Neurology, IRCCS C, Mondino Foundation and Clinical Pharmacology Unit, University of Pavia, Pavia, Italy (E.P.); Hospices Civils de Lyon, Lyon, France (P.R.); Sahlgren University Hospital, Göteborg, Sweden (E.B.-M.); and Epilepsy Centre of Berlin, Berlin, Germany (H.-J.M.).
- Venue
- Neurology
- Published
- 2007-02-06
- Volume
- 68
- Issue
- 6
- Pages
- 402-408
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- OpenAlex
- W2028500192
- Cited by
- 467
- References
- 1
- Citations by year
- 2026: 9 · 2025: 8 · 2024: 7 · 2023: 7 · 2022: 13 · 2021: 19 · 2020: 51 · 2019: 16 · 2018: 22 · 2017: 25 · 2016: 17 · 2015: 28 · 2014: 21 · 2013: 24 · 2012: 39
- FWCI
- 24.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neurology (publishedVersion)
- PubMed (publishedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Digital Access to Libraries (Université catholique de Louvain (UCL), l'Université de Namur (UNamur) and the Université Saint-Louis (USL-B)) (submittedVersion)
- Funders
- Union Chimique Belge
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmacological Effects and Toxicity Studies
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Keywords
- levetiracetam, newly diagnosed epilepsy, seizure freedom, antiepileptic drugs, first-line therapy, focal seizures, generalized tonic-clonic seizures, drug tolerability, dose optimization
- MeSH terms
- Levetiracetam, Adult, Anticonvulsants, Carbamazepine, Delayed-Action Preparations, Dose-Response Relationship, Drug, Double-Blind Method, Epilepsy, Female, Humans, Male, Piracetam, Treatment Outcome
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