Cenobamate for epilepsy effective across multiple treatment lines

The use of cenobamate across different treatment lines proves effective at reducing seizures in patients with epilepsy, according to real-world data.

Researchers conducted a retrospective, observational study and used data from the Drug-Resistant Epilepsy Registry of the Spanish Epilepsy Society using Research Electronic Data Capture. They identified 486 adult patients (mean age 42.8 years) with focal epilepsy who had received 2–6 prior antiseizure medications (ASMs) and had initiated cenobamate treatment at least 12 months before database closure.

For the primary effectiveness endpoint, changes in seizure frequency were assessed at 3, 6, and 12 months after cenobamate initiation according to different treatment lines. Adverse events (AEs) were also evaluated.

In the cohort, the mean number of prior ASMs was 4.4, and the mean number of concomitant ASMs at cenobamate initiation was 2.5. Treatment retention at 12 months was 92 percent, and the median cenobamate dose was 200 mg.

One-year seizure-freedom rates were 32.5 percent, 33.3 percent, 21.4 percent, 24.2 percent, and 11.4 percent among patients treated with 2–6 prior ASMs, respectively. Notably, significantly more patients with 2–3 (earlier treatment lines) achieved ≥50-percent, ≥75-percent, ≥90-percent, and 100-percent reduction in seizure frequency at 12 months compared with those who had received 4–6 prior ASMs (later treatment lines; p≤0.004).

Seizure severity improvements occurred in 71.9 percent of patients overall during follow-up.

In terms of safety, 56.4 percent of patients had AEs, with somnolence being the most common. AEs led to cenobamate discontinuation in 4.9 percent of patients.

The findings suggest that while cenobamate may be effective in later treatment lines, earlier use of the drug does improve seizure control in patients with focal seizures.