Efficacy And Safety Of Standard Or Topiramate For Monotherapy In Patients With Newly Diagnosed Epilepsy

Background: Antiepileptic drug (AED) monotherapy is the main strategy for patients with newly diagnosed epilepsy. Numbers of newer and older drugs supply more choice for clinical practice. However, it is still short of studies on the long-term efficacy and safety by comparision newer to older AEDs.This study aimed to evaluate efficacy and safety of newer and older AEDs in a large-sample Chinese cohort with newly diagnosed epilepsy.Methods: This was a retrospective unblinded nonrandomised study in outpatient clinic in Southwest China. Carbamazepine (CBZ), phenobarbital (PB), phenytoin (PHT), valproic acid (VPA) or topiramate (TPM) was chosen as an initial drug to treat patients with newly diagnosed epilepsy according to individualized treatment. The end points of this study included time to first AED monotherapy failure and time to clinical significant adverse effects. In addition, several risk factors were assessed, including gender, age, type of epilepsy, pattern of seizure, family history of epilepsy, febrile seizure, seizure frequency before therapy and drug choice.Findings: 1080 paients were recruited in this study. For the time of treatment failure, TPM was significantly better than CBZ (hazard ratio 0.64 [95%CI 0.42-0.99]), PHT (0.28 [0.17-0.46]), PB (0.32 [0.18-0.59]) and VPA (0.44 [0.30-0.67])。And elders,adults showed higher risk for treatment failure than children (elders: children HR 1.88 [1.06-21.67], adults: children HR 4.80 [1.10-3.20]. For the time to clinical significant adverse effects, TPM was significantly better than CBZ (0.46 [0.34-0.63]), PHT (0.38 [0.26-0.56]), PB (0.41 [0.27-0.64]) and VPA (0.56 [0.41-0.76]),and adults patients had more side efffects of clinical significance than children (adults: children 1.55 [95%CI 1.08-2.23]. Age, female gender and frequent seizure before treatment were risk factors for treatment failure.Conclusion: TPM is effective and safe drug for monotherapy in Chinese patients with newly diagnosed epilepsy for long-term therapy. Frequent seizure before treatment might be a predictor for poor prognosis. Female patients and children patients could be more concerned during treatment for better therapeutic efficacy and safty.