Topiramate works for secondary prevention of cyclic vomiting syndrome with red flags

Topiramate appears to be an effective second-line prophylactic medication against moderate-to-severe cyclic vomiting syndrome (CVS) in adults but at the cost of side effects, a study has shown.

Researchers looked at the medical records of 136 adult patients with CVS to characterize the response to topiramate as prophylactic therapy. They recorded clinical characteristics, number of CVS episodes, emergency department (ED) visits, and hospitalizations the year before and after initiating topiramate.

A total of 88 patients (65 percent) responded to topiramate, with response defined as a global improvement in symptoms or >50-percent reduction in the number of CVS episodes, ED visits, or hospitalizations.

Treatment led to a significant reduction in the annual number of CVS episodes (18.1 vs 6.2; p<0.0001), CVS-related ED visits (4.3 vs 1.6; p=0.0029), and CVS-related hospitalizations (2.0 vs 1.0; p=0.035). Logistic regression analysis showed that higher doses, prolonged use (≥12 months), and use of topiramate as monotherapy were associated with a response to treatment.

On the other hand, anxiety was associated with a lower likelihood of response.

In terms of safety, more than half of the patients (55 percent) experienced side effects, with 32 percent discontinuing the medication as a result. Cognitive impairment (13 percent), fatigue (11 percent), and paraesthesia (10 percent) were the most common side effects.

The vast majority of patients (92 percent) represented a refractory group in whom topiramate was initiated after failing treatment with tricyclic antidepressants.

The findings indicate a need to develop better-tolerated therapies for CVS.