Brief comparison between Newer vs Older AED

1. Older Antiepileptic’s vs Newer
Antiepileptic’s
Presented by
Noel.M.Isaac
Pharm D Intern

2. Older Antiepileptic’s vs Newer Antiepileptic’s
• Clinical Effectiveness
• Tolerability
• Cost-effectiveness

3. Investigation
1) Standard And New Antiepileptic Drugs (SANAD) Trial
SANAD was an unblinded randomised controlled trial in hospital-based
outpatient clinics in the UK.
2) Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) Trial
A prospective observational study of Fetal antiepileptic drug exposure and
cognitive outcomes

4. Standard And New Antiepileptic Drugs (SANAD)
Trial
• OBJECTIVES:
To compare clinicians' choice of one of the standard epilepsy drug
treatments (carbamazepine or valproate) versus appropriate comparator
new drugs.
• MAIN OUTCOME MEASURES:
– Time to treatment failure
(i.e. withdrawal of the randomised drug because of adverse events)
– Time to first seizure
– Time to achieve a 12-month remission of seizure’s.

5. Standard And New Antiepileptic Drugs (SANAD)
Trial
• The trial tested the effectiveness of
– Carbamazepine vs gabapentin vs lamotrigine vs oxcarbazepine vs
topiramate for treatment of partial epilepsy.
– Valproate vs lamotrigine vs topiramate for treatment of generalised and
unclassifiable epilepsy

6. Standard And New Antiepileptic Drugs (SANAD)
Trial
• Population under study is divided into 2 groups
– Group A, of the study recruiting 1721 patients (carbamazepine as standard)
– Group B, of the study recruiting 716 patients (Valproate as standard)

7. Effectiveness of Carbamazepine vs Newer
AED’s
• BACKGROUND:
– Carbamazepine is widely accepted as a drug of first choice for patients
with partial onset seizures. Carbamazepine was compared to several
newer anti-epileptic drugs to assess efficacy with regards to longer-term
outcomes, quality of life, and health economic outcomes.
• METHODS:
– Group A of the population was chosen for whom carbamazepine was
deemed to be standard treatment
– They were randomly assigned to receive carbamazepine, gabapentin,
lamotrigine, oxcarbazepine, or topiramate.

8. Effectiveness of Carbamazepine vs Newer
AED’s
• FINDINGS:
– Time to treatment failure: Lamotrigine was significantly better than
carbamazepine, gabapentin, topiramate, and oxcarbazepine.
– Time to 12-month remission: Carbamazepine was significantly better than
gabapentin, topiramate, and oxcarbazepine but almost similar to
Lamotrigine.
• INTERPRETATION:
– Lamotrigine is clinically better than carbamazepine, for time to treatment
failure outcomes and is therefore a cost-effective alternative for patients
diagnosed with partial onset seizures.

9. Effectiveness of Valproate vs Newer AED’s
• BACKGROUND:
– Valproate is widely accepted as a drug of first choice for patients with
generalised onset seizures, and unclassified seizures. Lamotrigine and
topiramate are also thought to possess broad spectrum activity. The
SANAD study aimed to compare the longer-term effects of these drugs in
patients with generalised onset seizures or seizures that are difficult to
classify.
• METHODS:
– Group B of the population was chosen for whom valproate was deemed
to be standard treatment
– They were randomly assigned to receive valproate, lamotrigine, or
topiramate.

10. Effectiveness of Valproate vs Newer AED’s
• FINDINGS:
– Time to treatment failure: Valproate was significantly better than
topiramate but similar to lamotrigine.
– For time to 12-month remission: Valproate was significantly better than
lamotrigine and for the subgroup with an idiopathic generalised epilepsy.
• INTERPRETATION:
– Valproate is better tolerated than topiramate and more efficacious than
lamotrigine, and should remain the drug of first choice for patients with
generalised and unclassified epilepsies.

11. Conclusion
New antiepileptic drugs offer many options in the treatment of epilepsy,
each with unique mechanisms of action as well as adverse effect profiles.
Although there is no evidence to suggest that the newer medications are
more efficacious, The new antiepileptic drugs are-
1. Well tolerated with few adverse effects,
2. Minimal drug interactions, and
3. A broad spectrum of activity.

12. Thank you