Quality of life and synergistic combinations of antiseizure medication in patients treated with cenobamate in early therapy lines for focal-onset seizures

Abstract

Background: Quality of life is an important outcome measure for patients with epilepsy (PWE). However, data on health-related quality of life (HRQoL) in PWE treated with cenobamate (CNB), a new antiseizure medication (ASM) that achieves a high level of seizure freedom, is scarce. These data are especially important for evaluating the use of CNB in early therapy lines for focal-onset seizures. Methods: The study population consisted of patients with focal-onset seizures that could not be controlled by fewer than three lifetime ASMs. They began treatment with CNB („CNB group“) or another ASM (controls). Both groups were matched at a ratio of 1:2 based on sex, age, and seizure frequency. HRQoL was evaluated using the Quality of Life in Epilepsy-10 (QOLIE-10), the EuroQol Visual Analogue Scale (EQVAS), and the EuroQol-5- Dimensions (EQ5D) questionnaire. The drug combinations were analyzed. Results: Of the 231 study participants, 33.3 % were treated with CNB, 19.0 % with valproate, 17.3 % with lacosamide, 16.4 % with levetiracetam, and 13.9 % with topiramate. The percentage improvement in the EQ5D index score from baseline to the 12-month follow-up was higher for CNB (32.2 %) than for other ASMs (3.2 %– 17.5 %, p < 0.05). Similar results were obtained for EQVAS (31 % vs. 3.2 %–17.5 %) and QOLIE-10 (46.9 % vs. 13.4 %–28.2 %), p < 0.05. CNB demonstrated superior seizure control and HrQoL when combined with low-dose clobazam and a trend for combination with SV2A modulators. Conclusion: Our study provides evidence that CNB in early therapy lines for focal-onset seizures is associated with an increased HrQoL. Low-dose clobazam can wok synergistically with CNB. The combination with SV2A mod ulators showed a positive trend.