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拉考沙胺添加治疗在中国儿童局灶性癫痫发作中的安全性与有效性

Safety and efficacy of oral Lacosamide as an add-on therapy in Chinese children with partial-onset seizures

摘要目的:评估拉考沙胺添加治疗用于中国局灶性癫痫发作儿童的安全性、耐受性和有效性。方法:SP848是一项全球多中心单臂研究,收集2018年4月至2019年5月在全国7所医院接受拉考沙胺添加治疗的4~17岁中国局灶性癫痫发作患儿60例,在足疗程且至少使用2种抗癫痫发作药(同期或序贯)治疗后,观察到患儿局灶性癫痫仍然控制不佳;添加口服拉考沙胺口服溶液(糖浆)或片剂。最低起始口服剂量为2 mg/(kg·d),研究期间最大允许服用剂量为12 mg/(kg·d)或600 mg/d,研究者根据患儿的耐受性和癫痫发作控制水平调整服用剂量。记录自基线期至末次访视每28 d局灶性癫痫的发作频率及中位变化百分比,包括50%应答率及75%应答率。结果:60例中国患儿进入期中分析,患儿平均年龄9.18(4.00~15.40)岁,男39例,女21例,平均癫痫病程为5.04(0.50~15.20)年。其中43例(71.7%)仍在接受治疗,1例(1.7%)完成了6个月至1年的随访,14例(23.3%)完成了6个月随访。自基线期至末次访视,患儿每28 d局灶性癫痫发作频率中位变化为-2.91,百分比变化中位数为-25.46%,50%和75%应答率分别为40.0%、28.3%。共有52例(86.7%)发生265起治疗中出现的不良事件(TEAE),其中11例(18.3%)发生19起严重TEAE,37例(61.7%)发生127起药物相关TEAE,11例(18.3%)发生16起导致终止研究的TEAE。最常见的TEAE为上呼吸道感染(20例,33.3%)、嗜睡(16例,26.7%)、头晕(15例,25.0%)和呕吐(13例,21.7%)。治疗期间未发现具有临床意义的心电图异常变化。结论:对其他药物控制不佳的≥4岁中国局灶性癫痫患儿,拉考沙胺是一种有效的添加治疗药物,耐受性良好。安全性特征与儿童和成人已报道的研究一致,未发现新的安全性问题。

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abstractsObjective:To evaluate the long-term safety, tolerability and efficacy of Lacosamide add-on therapy in Chinese children with partial-onset seizures.Methods:SP848 was a global multicenter single-arm study involving 60 Chinese children with partial-onset seizures with the age of 4-17 years who were managed by Lacosamide add-on therapy at seven hospitals across China from April 2018 to May 2019.After treatment with at least two kinds of anti-seizure medications simultaneously or sequentially, partial seizures were still poorly controlled and Lacosamide oral solution (syrup) or tablets were added.The minimum initial oral dose was 2 mg/(kg·d), and the maximum allowable dose was 12 mg/(kg·d)or 600 mg/d during the study period.The dose was adjusted according to the tolerance and seizure control level of partial-onset seizures children.Seizure frequency and the median percentage change in partial-onset seizures per 28 days from baseline to the final visit were recorded, including 50% responder rate and 75% responder rate.Results:A total of 60 Chinese children with the mean age of 9.18 (4.00-15.40) years were included in this interim analysis, involving 39 males and 21 females.The mean course of epilepsy was 5.04 (0.50-15.20) years.A total of 43 patients (71.7%) still have been treated.One patient (1.7%) has completed the 6-12 months of follow-up, and 14 patients (23.3%) have completed the follow-up for less than 6 months.The median change in the frequency of partial seizures every 28 days from baseline to the last visit was -2.91, with its median percentage as -25.46%, and the proportions of ≥50%, while ≥75% responder rate were 40.0% and 28.3%, respectively.A total of 52 patients (86.7%) had 265 treatment emergent adverse events (TEAE), 11 patients (18.3%) had 19 serious TEAE, 37 patients (61.7%) had 127 drug-related TEAE, and 11 patients (18.3%) had 16 TEAE leading to the discontinuation of the trial.The most common TEAE were upper respiratory tract infections (20 cases, 33.3%), followed by drowsiness (16 cases, 26.7%), dizziness (15 cases, 25.0%) and vomiting (13 cases, 21.7%). There were no abnormal changes in the electrocardiographic findings during the treatment.Conclusions:For Chinese patients with partial seizures who are older than the age of 4 years and poorly controlled by other drugs, Lacosamide is effective and well tolerated as an add-on therapy drug.The safety characteristics are consistent with those reported in children and adults.No new safety concerns are identified.

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