HarmoniaMentis Sverige
Summary from the Angelini Pharma Satellite Symposium at EAN 2024
THE FINE LINE BETWEEN UNDERTREATMENT AND OVERTREATMENT IN UNCONTROLLED EPILEPSY
SUMMARY OF ANGELINI PHARMA SATELLITE SYMPOSIUM AT EAN 2024
This year, Angelini Pharma has had the honor of supporting the 10th Congress of the European Academy of Epilepsy with a satellite symposium with an esteemed international faculty:
Prof. Jukka Peltola (Chair, FIN), Dr. Angel Aledo-Serrano (SPA) and Dr. Magdalena Bosak (PL).
Below are the key topics discussed in the symposium summarised – have a good read!
How to balance patient needs in the shifting
epilepsy management
- Pharmacological treatments include more than 30 different drugs. The overall management of epilepsy remains complex.1
- While new epilepsy therapies are developed, knowledge of the pharmacokinetics, antiseizure efficacy and spectrum, and AE profiles of currently used ASMs is an essential component of treating epilepsy successfully and maintaining a high QoL for every patient, particularly in case of DRE.2
- Both overtreatment and undertreatment with ASMs should be avoided.3
Prof. Jukka Peltola
Department of Neurology,
Tampere University and Tampere University Hospital, Finland
Overtreatment: missing the change
to reduce treatment burden
- Overtreatment may be defined as an excessi ve drug load (that is, excessive drug dosages or unnecessary polypharmacy) leading to a suboptimal risk-to-benefit ratio.⁴
- Sometimes just changing combinations and dose adjustments could reduce the number of side effects and improve seizure control.⁵
- Optimization of co-ASM management during CNB treatment allowed high seizure freedom rates despite meaningful reductions in co-medication, while also achieving both good tolerability and patient satisfaction scores in a highly drug-resistant population.⁶
Prof. Magdalena Bosak
Jagiellonian University Medical College,
University Hospital in Kraków - Kraków, Poland
Undertreatment: missing the chance
to reduce seizure burden
- Therapeutic inertia, sometimes referred to as clinical inertia, has been defined as failure to initiate or intensify therapy when therapeutic goals are not reached.7
- Unfortunately, treatment of patients with uncontrolled epilepsy with suboptimal doses may prevent seizure remission.3
- Real-world, good effectiveness outcomes of cenobamate are consistent with data from clinical trials, with higher dosages needed to achieve seizure freedom in patients with highly DRE.8
- Open and regular communication between the patient and provider is critical to improve adherence, and it is recommended to check in with the patient before or when reaching the 100-mg dose.9
Dr. Ángel Aledo-Serrano
Vithas Clinical Neuroscience Institute Vithas Madrid University Hospitals
CNB, cenobamate; ASM, anti-seizure medicine
Ontozry® (cenobamat) 12,5 mg odragerad tablett samt 25 mg, 50 mg, 100 mg, 150 mg och 200 mg filmdragerade tabletter. Rx F. ATC-kod: N03AX25 - antiepileptika, övriga antiepileptika. Indikation: Ontozry är indicerat som tilläggsbehandling av fokala anfall, med eller utan sekundär generalisering hos vuxna patienter med epilepsi, som inte kontrollerats tillräckligt trots tidigare behandling med minst två antiepileptika. Kontraindikationer: Överkänslighet mot den aktiva substansen eller mot något hjälpämne, ärftligt kort QT-syndrom. Varningar: Patienter ska uppsöka läkare om tecken på självmordstankar/självmordsbeteende uppstår, samt om tecken och symptom på läkemedelsreaktion med eosinofili och systemiska symtom (DRESS) inträffar. Innehåller laktos. Cenobamat kan minska exponeringen av substanser som metaboliseras via CYP3A4, CYP2B6 samt öka exponeringen av substanser som metaboliseras via CYP2C19. Cenobamat rekommenderas inte till fertila kvinnor som inte använder preventivmedel eller vid amning. MAH: Angelini Pharma S.p.A. Lokal kontakt: Angelini Pharma Nordics, nordic.medinfo@angelinipharma.com. Datum för senaste översyn av SPC: 11/2023. För AUP och ytterligare information, se www.fass.se. ▼Detta läkemedel är föremål för utökad övervakning.
You may also be interested in the summaries of our 2 symposia held at 15th European Epilepsy Congress in Rome, available also here in Harmoniamentis website.
References
- Ben-Menachem E, Schmitz B, Kälviäinen R et al. The burden of chronic drug-refractory focal onset epilepsy: Can it be prevented? Epilepsy Behavior 2023 Nov:148:109435. doi: 10.1016.
- Löscher W, Klein P. The pharmacology and clinical efficacy of antiseizure medications: From bromide salts to cenobamate and beyond. CNS Drugs. 2021; 35(9): 935-963.
- Schmidt D. Drug treatment of epilepsy: Options and limitations. Epilepsy & Behavior. 2009 May 1;15(1):56-65.
- Perucca E, Kwan P. Overtreatment in Epilepsy: How It Occurs and How It Can Be Avoided. CNS Drugs. 2005; 19 (11): 897-908.
- Dash D, Aggarwal V, Joshi R et al. Effect of reduction of antiepileptic drugs in patients with drug-refractory epilepsy. Seizure. 2015 Apr;27:25-9.
- Rodríguez‐Uranga JJ, et al. Treatment simplification to optimize cenobamate effectiveness and tolerability: A real-world retrospective study in Spain. Epilepsia Open. 2024 May 27. DOI: 10.1002/epi4.12959.
- Usherwood T. Therapeutic inertia. Australian Prescriber. 2024 Feb;47(1):15.
- Villanueva V, Santos-Carrasco D, Cabezudo-García P et al. Real-world safety and effectiveness of cenobamate in patients with focal onset seizures: Outcomes from an Expanded Access Program. Epilepsia Open. 2023;8(3):918-929.
- Steinhoff B, Ben-Menachem E, Klein P et al. Therapeutic strategies during cenobamate treatment initiation: Delphi panel recommendations. Ther Adv Neurol Disord. 2024, Vol. 17: 1–10.
SW26304P Dec 2024
