Skutki uboczne nowoczesnych leków przeciwpadaczkowych zgłaszane przez pacjentów: porównanie leczenia jednym lekiem i dwoma lekami u chorych na epilepsję
Patient-reported adverse effects of selected newer-generation antiseizure medications: comparison of monotherapy and dual therapy in patients with epilepsy
W skrócie
Badacze porównali działania niepożądane leków przeciwpadaczkowych u pacjentów przyjmujących jeden lek versus dwa leki jednocześnie. Okazało się, że leczenie dwoma lekami zwykle nie powoduje więcej efektów ubocznych niż jeden lek, choć w niektórych kombinacjach pacjenci odnotowali więcej problemów z równowagą, przybraniem na wadze i pamięcią. Wyniki pokazują, że leczenie powinno być dostosowane indywidualnie do każdego pacjenta i nie należy bez powodu stosować wielu leków naraz.
Oryginalny abstract (angielski)
BACKGROUND: Epilepsy is a common chronic neurological disorder primarily treated with antiseizure medications (ASMs), which may cause adverse effects that negatively affect quality of life. Using the validated Adverse Event Profile (AEP), a patient-reported measure of subjective treatment-associated side effects, this study aimed to compare the burden of subjective adverse effects in patients receiving monotherapy versus dual therapy. METHODS: We analysed data from 259 patients treated at a German tertiary epilepsy center who completed the AEP questionnaire. Adverse effects under monotherapy were compared with those under dual therapy by evaluating individual AEP items, subscale scores, and total scores. Common monotherapies - levetiracetam (LEV), lamotrigine (LTG), brivaracetam (BRV), and lacosamide (LCM) - were compared with frequent dual therapy combinations (BRV + LCM, BRV + LTG, LCM + LEV, and LEV + LTG). RESULTS: Overall, no significant differences in adverse effect burden were observed between monotherapy and dual therapy. Within the LEV subgroup, patients receiving LEV + LTG (n = 32) reported significantly higher scores for unsteadiness (p = 0.023), weight gain (p = 0.021), and memory problems (p = 0.009) compared with LEV monotherapy; no significant differences were observed for LTG monotherapy. CONCLUSION: In this cohort, dual therapy with newer-generation ASMs was not associated with a higher overall burden of adverse effects. Given the retrospective, cross-sectional design and small subgroup sizes, these findings should be considered exploratory and require confirmation in larger prospective studies. Unnecessary polytherapy should be avoided, and ASM treatment should remain individualised.