Balancing New Medications and Reducing Adverse Effects in Epilepsy Treatment: Louis Ferrari, RPh, MBA

WATCH TIME: 5 minutes

"If you just keep adding medications without strategically reducing others, patients may experience more adverse effects, leading to challenges in medication adherence. The new study highlights the need for a balanced approach, ensuring patients are not quick to blame new medications for adverse events but rather focus on optimizing the overall drug regimen."

Cenobamate (Xcopri; SK Life Science), a sodium channel antagonist, received FDA approval as a medication for partial-onset seizures in November 2019. The therapy had its safety and efficacy assessed and confirmed in 2 previous pivotal trials: Study 013 (NCT01397968) and Study 017 (NCT01866111). In these studies, 28% of patients who received cenobamate 200 mg/day and 21% of patients who received cenobamate 400 mg/day achieved 100% seizure reduction during their 6-week and 12-week maintenance phases, respectively.¹ Since the completion of those studies, the profile of cenobamate has expanded with further analyses.

In a new post hoc analysis, pharmacokinetic and pharmacodynamic data from the open-label phase 3 Study C021 (NCT02535091) showed that adjustments of concomitant antiseizure medications (ASM) should be performed earlier in the treatment with cenobamate.² Additionally, these findings support the notion that modulating dosages of adjunctive ASMs can lead to improved retention. The results were presented at the 2023 American Epilepsy Society Annual Meeting, held December 1-5, in Orlando, Florida, by lead author Louis Ferrari, RPh, MBA, vice president of medical affairs at SK Life Science, and colleagues.

Ferrari sat down in an interview with NeurologyLive® during the meeting to discuss results from the recent study and how the study recommends balancing the addition of new ASMs with the reduction of older drugs to enhance patient outcomes. Ferrari also spoke about the challenges that arise when physicians overlook the importance of strategically managing concomitant medications in epilepsy treatment. Additionally, he explained how healthcare providers can address the common misconception that adverse events are solely attributed to the newest medication, leading to premature discontinuation.

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REFERENCES
1. Abou-Khalil B, Aboumatar S, Klein P, Krauss GL, Sperling MR, Rosenfeld WE. Efficacy of cenobamate for uncontrolled focal seizures in patients with previous epilepsy-related surgery: Post hoc analysis of a phase 3, multicenter, open-label study. Epilepsy Res. 2022;184:106952. doi:10.1016/j.eplepsyres.2022.106952
2. Ferrari L, Kamin M, Rosenfeld W. Dose Reduction Timing for Concomitant Antiseizure Medications: Post-hoc Analysis of a Phase 3, Open-Label Study of Cenobamate for Treatment of Uncontrolled Focal Seizures. Presented at: AES 2023; December 1-5; Orlando, FL. Abstract 1.278