Antiepileptic drug discontinuation by people with epilepsy in the general population. (26th July 2017)

• Record Type: Journal Article
• Authors: Giussani, Giorgia; Bianchi, Elisa; Canelli, Valentina; Erba, Giuseppe; Franchi, Carlotta; Nobili, Alessandro; Sander, Josemir W.; Beghi, Ettore
• Other Names: Agostoni Elio investigator.; Airoldi Larissa investigator.; Basso Francesco investigator.; Carpanelli Marialuisa investigator.; Di Stefano Mariolina investigator.; Magnoni Andrea investigator.; Martinelli Ottaviano investigator.; Rigamonti Andrea investigator.; Salmaggi Andrea investigator.; Stanzani Lorenzo investigator.; Volpe Cristina investigator.; Zanotta Nicoletta investigator.; Zucca Claudio investigator.; Agudio Marco investigator.; Arienti Flavio investigator.; Arrigoni Graziano Rocco investigator.; Balestra Giancarlo investigator.; Ballabio Piercarla investigator.; Balossi Stefano Marco investigator.; Baratti Maria Rita investigator.; Barteselli Fabrizia Enrica investigator.; Bellani Fausto investigator.; Bellani Mauro investigator.; Bellini Gianpiero investigator.; Beretta Pier Aldo investigator.; Beretta Roberto investigator.; Bergamini Massimo investigator.; Bertella Annalisa investigator.; Bertolini Francesco investigator.; Bevilacqua Rolando investigator.; Bianchi Marcellino Arturo investigator.; Bigiolli Patrizia investigator.; Binda Giuseppe investigator.; Biondelli Gigliola investigator.; Bodega Libero investigator.; Bolis Edoardo Giovanni investigator.; Vincenzo Marco investigator.; Bolla Carlo investigator.; Bonacina Carlo Ambrogio investigator.; Bonfanti Marco investigator.; Borghetti Fausta investigator.; Brambilla Roberto investigator.; Brancaleone Wilma investigator.; Brusadelli Francesco investigator.; Bub Sabine investigator.; Caccia Giovanna investigator.; Caglio Myriam investigator.; Rossi Carlo Calvi investigator.; Capra Daniela investigator.; Carone Davide investigator.; Carì Giuseppe investigator.; Carrera Silvio investigator.; Cavenago Rosalia investigator.; Cecchetti Maria Luisa investigator.; Centonze Bice Antonella investigator.; Cereghini Fabio investigator.; Cerrone Ciro investigator.; Ciappetta Maria Pia investigator.; Cogliati Bruno investigator.; Colombano Ombretta investigator.; Colombo Alberto investigator.; Colombo Daniela investigator.; Corti Maria Lia investigator.; Cremonini Nicla investigator.; Crippa Marco investigator.; Crippa Rolando Antonio investigator.; Crotta Mario investigator.; Curto Salvatore investigator.; Daielli Patrizia investigator.; De Gilio Domenico investigator.; De Pascalis Giuseppe Pasquale investigator.; Decet Elena investigator.; Della Morte Luigi investigator.; Duvia Felice investigator.; Favorito Antonia investigator.; Ferrario Roberto investigator.; Fezzi Luigi investigator.; Laura Finzi Angela investigator.; Fiorentino Bruno Ugo investigator.; Fornaciari Agnese investigator.; Franceschetti Silvana investigator.; Fulconis Fabio investigator.; Fumagalli Giovanni investigator.; Fumagalli Maurizio investigator.; Galbiati Giuseppe investigator.; Andrea Galimberti Carlo investigator.; Gecchele Donatella investigator.; Ghiazza Barbara investigator.; Ghislanzoni Paolo investigator.; Gioffredi Laura investigator.; Hassibi Taraneh investigator.; Julita Simone investigator.; Leone Giuseppe investigator.; Levi Claudio investigator.; Locatelli Giovanni investigator.; Locati AnnaAlessandra investigator.; Longhi Enrico Giovanni investigator.; Lukacova Ingrid investigator.; Manfroi Mauro Giovanni investigator.; Manzoni Paola investigator.; Marcolini Claudio investigator.; Minicucci Fabio investigator.; Martini Mohammed Safwan investigator.; Masperi Rita investigator.; Mayan Sussele investigator.; Mazzoleni Valeria investigator.; Menga Antonio investigator.; Merlini Fiorella investigator.; Messina Enrico investigator.; Micheli Marta investigator.; Micò Rocco investigator.; Millul Andrea investigator.; Montini Barbara investigator.; Palazzuolo Alberto investigator.; Panzeri Silvano Primo investigator.; Passoni Giovanni investigator.; Pensotti Laura investigator.; Petrone Maria Marcella investigator.; Pezzuto Roberto investigator.; Pigazzini Elisabetta investigator.; Pirovano Nicoletta investigator.; Pontiggia Margherita investigator.; Pozzi Roberto investigator.; Quadrelli Carlo investigator.; Rampello Filomena investigator.; Realini Marco investigator.; Righetti Giovanni investigator.; Ripa Cesare investigator.; Rivetta Sonia investigator.; Romeo Antonino investigator.; Rota Carlo investigator.; Rusconi Tiziana investigator.; Santarpia Andrea investigator.; Santi Ivana investigator.; Sciani Luigi investigator.; Scoccimarro Gianni investigator.; Scopinaro Eugenio investigator.; Semerano Angelo Giuseppe investigator.; Sferco Daniela investigator.; Sirtori Anna Ersilia investigator.; Spandri Angela investigator.; Spinelli Bruno investigator.; Stefanoni Fausto investigator.; Taiana Raffaele investigator.; Tamagnini Libero investigator.; Tassi Laura investigator.; Tentori Giorgio investigator.; Teodoro Augusto investigator.; Tinterova Katerina investigator.; Tocchetti Ampelio investigator.; Todeschini Michela investigator.; Trezza Lorenzo investigator.; Valsecchi Valter investigator.; Vanini Roberto investigator.; Vercelloni Claudio Felice investigator.; Villella Anna investigator.; Viola Maria investigator.; Vismara Pietro investigator.; Zoboli Daniele Mario investigator.;
• Is Part Of: Epilepsia. Volume 58:issue 9(2017)
• Page Start: 1524
• Page End: 1532
• Publication Date: 2017-07-26
• Subjects: Epilepsy -- Antiepileptic drugs -- Discontinuation; Epilepsy -- Periodicals; 616.853
• DOI: 10.1111/epi.13853
• Languages: English
• ISSNs: 0013-9580

Abstract

Summary: Objective: Rate, reasons, and predictors of antiepileptic drug (AED) discontinuation were investigated in a well‐defined cohort of people with epilepsy to verify efficacy and tolerability of treatment up to 20 years from treatment initiation. Methods: The history of AED usage in children and adults with epilepsy registered with 123 family physicians in an area of Northern Italy between 2000 and 2008 was recorded. Cumulative probabilities of AED withdrawal for specific reasons were estimated using cumulative incidence functions. The probabilities of withdrawing for terminal remission, and of achieving sustained remission while still on treatment, were also evaluated. The roles of sex, age at diagnosis, seizure types, duration at diagnosis, and syndrome were assessed with hazard ratios and 95% confidence intervals. Results: Seven hundred thirty‐one of 747 individuals were treated with one or more AEDs during the disease course. The three commonest drugs were valproate, carbamazepine, and phenobarbital. Reported reasons for AED withdrawal were, in decreasing order, terminal remission, ineffectiveness, and adverse events. The probability of withdrawing the first AED for terminal remission was 1.0% at 1 year and increased to 20.0% at 20 years. Corresponding rates were 2.9% and 12.6% for ineffectiveness and 0.5% and 3.3% for adverse events. Reasons for withdrawal varied with individuals' age, sex, disease characteristics, and drugs. Significance: The initial AED given was retained in the majority of cases. Terminal remission, lack of efficacy, and adverse effects were, in decreasing order, the commonest reasons for AED discontinuation. Withdrawal could be predicted by age at diagnosis, sex, and clinical characteristics and varies among drugs.