מתוך medicontext.co.il
By Joene Hendry
WESTPORT, CT (Reuters Health) – In teenage epilepsy patients, those treated with lamotrigine maintained stable weight while those treated with valproate showed pronounced weight gain within 10 weeks of beginning therapy.
"The aspect of weight gain is extremely important in teenagers," said Dr. Victor Biton of the Arkansas Epilepsy Program in Little Rock. "Even though [valproate] is very effective, it is discontinued frequently because of this problem of weight gain," he told Reuters Health during a telephone interview.
In a double-blind study, Dr. Biton and colleagues compared lamotrigine monotherapy in 12 adolescents with new-onset partial or generalized seizures against valproate monotherapy in 13 adolescents, 12 to 17 years old. Dr. Biton presented the findings Tuesday during the American Epilepsy Society meeting in Philadelphia.
The patients underwent an 8-week titration phase to reach target dosages of 200 to 500 mg/day lamotrigine or 20 to 60 mg/kg/day valproate followed by 24 weeks of maintenance therapy. The investigators compared the patients' body weight at baseline to their weight at 10, 14, 20, 26, and 32 weeks after initiating treatment.
After 10 weeks of treatment, Dr. Biton noted, the lamotrigine group had a mean weight gain of 2.6 pounds from a baseline mean weight of 62 pounds. By comparison, the valproate group showed a mean weight gain of 7 pounds from a mean baseline weight of 60 pounds.
"With valproate the weight gain never reached a plateau," Dr. Biton said. At 32 weeks his team found that the lamotrigine-treated patients had gained a mean of 1.9 pounds from baseline while the valproate group had gained a mean of 13.9 pounds.
Dr. Biton's team reports that 25% of the lamotrigine patients and 31% of the valproate group were seizure-free during the 8-month study. However, the dropout rate was significantly higher in the valproate group compared with the lamotrigine group, Dr. Biton said. Tremor, hair loss, nausea and vomiting were more common with valproate therapy while headache and asthenia were more common with lamotrigine therapy.
Dr. Biton believes that, when treating adolescents for seizure disorders, physicians should "switch gears from considering valproate as the first-line drug to lamotrigine as the first-line drug."
"Lamotrigine is as effective and does not cause weight gain," he said.
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