Impact of long-term treatment with cenobamate on concomitant usage of antiseizure medications: A real-world retrospective study in Spain.

objectivesThis study explored the safety and effectiveness of adjunctive cenobamate (CNB) in patients with different levels of drug-resistant epilepsy (DRE) in a real-world setting, including its impact on the use of co-antiseizure medication (co-ASM).

methodsThis was a single-center, retrospective, observational study. Adults with refractory seizures who had received ≥2 previous ASMs and had been treated with CNB for at least a year were included. Effectiveness and safety endpoints were assessed at 3, 6, 12, and 24 months after CNB was initiated. Co-ASM use was assessed at every visit.

resultsNinety-four patients were included; 23 of 94 (24.5%) had received ≤4 previous ASMs and 70 of 94 (74.5%) had received ≥5 previous ASMs. Patients with ≥5 previous ASMs had a younger age at onset (mean 12 vs 25.9 years) and a longer duration of epilepsy (mean 28.1 vs 16.7 years) compared with patients with ≤4 previous ASMs. The mean CNB daily dose was 310 ± 76.7 mg at 2 years. The mean number of co-ASMs received by patients was reduced significantly between baseline and all time points (p ≤ .01). The mean defined daily dose (DDD) per patient (not including CNB) was also reduced significantly across all time points (p < .01), falling from 3.2 ± 2.3 at baseline to 1.2 ± 1.9 at the 2-year follow-up. At 1 and 2 years after initiation of CNB, 79.6% and 80% of patients had a ≥50% reduction in seizure frequency and 36.6% and 30.9% were seizure-free, respectively. At 2 years, 73.2% of patients reported their condition to be "Very much better" or "Much better" compared with baseline; 37.5% reported treatment-related adverse drug reactions at 2 years. SIGNIFICANCE: In patients with DRE, CNB treatment allowed long-term high seizure-freedom rates and significant reductions in co-ASM use, while also achieving both good tolerability and high patient satisfaction scores.