Study reinforces guideline to avoid prescribing EIASMs in glioma patients with epilepsy

First-line monotherapy with levetiracetam (LEV) appears to have a more favourable effectiveness than enzyme-inducing antiseizure medications (EIASMs) in glioma patients with epilepsy, owing to lower treatment failure for any reason and better tolerability, according to a study, which supports the current neuro-oncology recommendations to avoid EIASMs in this population.

The retrospective observational study included 808 patients with grade 2–4 glioma, of whom 109 were prescribed first-line LEV and 183 EIASMs (carbamazepine, oxcarbazepine, phenobarbital, phenytoin).

Compared with patients in the EIASM group, those in the LEV group were more likely to have a high-grade glioma (83 percent vs 68 percent; p=0.013) and have been treated in large epilepsy centres (94 percent vs 84 percent; p=0.006) but less likely to have had surgical resection (40 percent vs 57 percent; p=0.005) at baseline.

Over a maximum follow-up duration of 36 months, the primary outcome of antiseizure medication treatment failure for any reason occurred more frequently in the EIASM group than in the LEV group (68 percent vs 38 percent; adjusted hazard ratio [aHR], 1.82, 95 percent confidence interval [CI], 1.20–2.75; p=0.005).

The risk of treatment failure due to uncontrolled seizures was not significantly different between the EIASM and LEV groups (aHR, 1.32, 95 percent CI, 0.78–2.25; p=0.300). However, the risk of treatment failure due to adverse effects was more than fourfold higher with EIASMs (aHR, 4.87, 95 percent CI, 1.89–12.55; p=0.001).

The findings back the recommendations to avoid prescribing EIASMs in glioma patients and to consider LEV as the first-line antiseizure medication in glioma patients with epilepsy without a history of psychiatric disease, such as anxiety.