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Three Meds Equal as Second-Line Therapy for Status Epilepticus

Levetiracetam, fosphenytoin, valproate treat seizures unresponsive to benzodiazepine in children, adults

WEDNESDAY, Nov. 27, 2019 (HealthDay News) — Levetiracetam, fosphenytoin, and valproate are equally effective in children and adults for the treatment of benzodiazepine-refractory convulsive status epilepticus, according to a study published in the Nov. 28 issue of the New England Journal of Medicine.

Jaideep Kapur, M.B., B.S., Ph.D., from the University of Virginia in Charlottesville, and colleagues conducted a randomized trial to compare the safety and efficacy of levetiracetam, fosphenytoin, and valproate for children and adults with convulsive status epilepticus unresponsive to benzodiazepine treatment. A total of 384 patients were enrolled and randomly assigned to either levetiracetam, fosphenytoin, or valproate (145, 118, and 121 patients, respectively).

A planned interim analysis led to the trial being stopped in accordance with the prespecified rule for futility of finding one drug to be superior or inferior. The researchers determined that 10 percent of the enrolled patients had had psychogenic seizures. The primary outcome of cessation of status epilepticus and improvement in the level of consciousness at 60 minutes occurred in 47, 45, and 46 percent of patients assigned to levetiracetam, fosphenytoin, and valproate, respectively. The posterior probability was 0.41, 0.24, and 0.35, respectively, for each drug being most effective.

“Having three equally effective second-line intravenous medications means that the clinician may choose a drug that takes into account individual situations,” write the authors of an accompanying editorial.

Several authors disclosed financial ties to the biopharmaceutical industry.

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