Highlights from

EAN 2019

European Academy of Neurology

Oslo 29 June - 2 July 2019

Clinical and cost effectiveness of levetiracetam vs valproate

The longer-term clinical and cost effectiveness of levetiracetam and valproate in newly diagnosed generalised and unclassified epilepsy have been compared in a randomised trial [1]. Levetiracetam was not non-inferior to valproate for time to 12-month remission, and was inferior for time to treatment failure for inadequate seizure control and for time to 24-month remission.

The so-called Standard And New Antiepileptic Drugs II (SANAD II) study was a randomised unblinded controlled trial comparing starting treatment with levetiracetam or valproate in patients with generalised (n=396) and unclassified (n=124) epilepsy. The trial was designed to assess the non-inferiority of levetiracetam for time to 12-month remission. Levetiracetam was not found to be non-inferior to valproate for this endpoint: HR 1.19 (non-inferiority margin: 1.314). The HR was not constant over time. After 3 years, there was little to no difference between the 12-month remission rates for each group. In the levetiracetam group, 24% had an immediate 12-month remission, compared to 33% in the valproate group.

Valproate was superior to levetiracetam for time to treatment failure (HR 0.65). It was also superior for time to first seizure (HR 0.82), and time to 24-month remission (HR 1.43). No difference was found in treatment failure due to adverse events (HR 0.93), but valproate was superior for treatment failure due to inadequate seizure control (HR 0.43). In the original SANAD study, which assessed valproate compared to other therapies in 716 patients, valproate was shown to be better tolerated than topiramate and more efficacious than lamotrigine [2].

  1. Marson T, et al. EAN 2019, O4125.
  2. Marson AG, et al. Lancet. 2007;369(9566):1016-26.

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