Epilepsy
Conditions
Keywords
Epilepsy, Partial Onset Seizures, Lacosamide, Monotherapy, Vimpat
Brief summary
The objective of this historical-controlled trial is to demonstrate the efficacy and safety of conversion to Lacosamide monotherapy in subjects with Partial-onset Seizures who are withdrawn from 1 to 2 marketed antiepileptic drugs.
Detailed description
Sudden unexplained death in epilepsy have been reported in epilepsy patients. A causal relationship with the administration of antiepileptic drugs has not been established. The most important known risk factor for sudden unexplained death in epilepsy (SUDEP) is the occurrence and frequency of generalized tonic-clonic seizures (GTCS). Twenty-seven patients with only GTCS were enrolled in the conversion to monotherapy study. In this study, two patients with only GTCS had SUDEP. Due to the potential increased risk of SUDEP in patients with only GTCS in a trial setting, the 1 remaining patient with only GTCS was withdrawn from this study.
Interventions
50 mg and 100 mg tablets provided for 200 mg twice daily dosing for up to 20 weeks.
Sponsors
Study design
Eligibility
Inclusion criteria
* Subject has a diagnosis of Epilepsy with Simple Partial Seizures (motor component) and or Complex Partial Seizures (with or without secondary generalization) * Must be experiencing 2 to 40 seizures per 28-day period * Stable dose of 1 or 2 marketed antiepileptic drugs * Second Antiepileptic Drug (AED) must be less than or equal to 50 % of the minimum recommended maintenance dose per USA product label at screening
Exclusion criteria
* Subject has a history of primary generalized or unclassified seizures * Seizure disorder primarily characterized by isolated auras * History of status epilepticus * Seizures that are uncountable due to clustering * Has greater than 5 seizures/day * Subjects taking Benzodiazepines, Phenobarbital or Primidone * Subject has Vagus Nerve Stimulation (VNS) * Significant medical or psychiatric condition * History of alcohol or drug abuse * History of Ethosuximide use, Felbamate use after 1994 or Vigabatrin use after 1997
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Subjects (Using Kaplan-Meier) Who Are Identified As Meeting At Least 1 Pre-defined Exit Criteria By Day 112 Relative To The Start of Withdrawal of Background Antiepileptic Drug(s) | 16 Weeks Maintenance Period (approximately 112 days) | Pre-defined exit criteria: 1. A 2-fold or greater increase in average monthly (28-day) partial seizure frequency (motor and non-motor) compared to average monthly partial seizure frequency (motor and non-motor) during the Baseline Phase 2. A 2-fold or greater increase in consecutive 2-day partial seizure frequency (motor and non-motor) versus the highest consecutive 2-day partial seizure frequency (motor and non-motor) that occurred during the Baseline Phase. Note: if the highest consecutive 2-day partial seizure frequency during the Baseline Phase is 1, a 2-day partial seizure frequency of ≥3 is required to meet this exit criterion 3. Occurrence of a single generalized tonic-clonic seizure if none had occurred in the 6 months prior to randomization 4. A prolongation or worsening of overall seizure duration, frequency, type or pattern considered by the investigator as serious enough to warrant trial discontinuation 5. Status epilepticus, or new onset of serial/cluster seizures |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to First Occurrence of Any Exit Event During The Maintenance Period | 16 Weeks Maintenance Period (approximately 112 days) | The time to first occurrence (days) of any exit event was estimated using Kaplan-Meier methods and was based on the time from the start of the Maintenance Phase to the earliest date a subject met an exit criterion. Subjects who discontinued during the Maintenance Phase due to non-exit criteria reasons or who completed the Maintenance Phase before 112 days and did not meet an exit criterion were censored as of the last Maintenance Phase dose date. Subjects completing 112 days in the Maintenance Phase were censored as of Day 112. |
| Percentage of Subjects (Using Kaplan-Meier) Who Are Identified as Meeting at Least 1 Pre-defined Exit Criteria by Day 112, Withdrew Due to Adverse Event (AE) or Withdrew Due to Lack of Efficacy During The Maintenance Period | 16 Weeks Maintenance Period (approximately 112 days) | Subjects were classified as having an exit event if they experienced at least 1 of the following events during the Maintenance Phase as of Day 112: 1. Met at least 1 exit criterion based on the calculations applied for the Primary Efficacy Analysis 2. Withdrawal due to AE with onset during the Maintenance Phase 3. Withdrew prematurely due to lack of efficacy during the Maintenance Phase The date the subject experienced the event was set to the earliest date the subject met an exit criterion or the date of the last Maintenance Phase dose for subjects not meeting an exit criterion but withdrawing due to an AE or lack of efficacy. The secondary analysis is only conducted on the Lacosamide 400 mg/day group. |
| Duration of Monotherapy Treatment During the Monotherapy Phase of The Maintenance Period (Visit 9 - Visit 12) | Visit 9 - Visit 12 (approximately 10 weeks) | Days on Monotherapy Treatment were defined as the number of days during the Monotherapy Phase when the subject took Lacosamide (LCM) only (ie, the total number of days exposed to LCM during the Monotherapy Phase minus any days where a concomitant or rescue Anti-epileptic Drug (AED) was taken by the subject). The days on Monotherapy Treatment did not need to be consecutive. |
| Clinical Global Impression of Change (CGIC) From Baseline To Last Visit | Baseline; Last Visit (approximately 27 weeks) | For the assessment of the Clinical Global Impression of Change (CGIC), the investigator should provide his/her assessment of the subject's clinical status, compared to Baseline, including an evaluation of seizure frequency and intensity, the occurrence of AEs, and subject's functional status. He was asked the following:Please check the number that best describes the subject's condition over the past 4 weeks compared to Baseline: 1. Very much improved 2. Much improved 3. Minimally improved 4. No change 5. Minimally worse 6. Much worse 7. Very much worse |
| Patient's Global Impression of Change (PGIC) From Baseline To Last Visit | Baseline; Last Visit (approximately 27 weeks) | For the assessment of the Patient's Global Impression of Change, the subject should provide his/her assessment of his/her own clinical status, compared to Baseline, including an evaluation of seizure frequency and intensity, the occurrence of AEs, and subject's functional status.The subject was asked to answer the following: Over the past 4 weeks, how have you felt compared to before you entered this clinical trial? (Please check the number that best describes your condition.) 1. Very much improved 2. Much improved 3. Minimally improved 4. No change 5. Minimally worse 6. Much worse 7. Very much worse |
Countries
Australia, Austria, Canada, Denmark, France, Germany, Ireland, Italy, Poland, Puerto Rico, Spain, United Kingdom, United States
Participant flow
Recruitment details
The study was conducted at 160 sites in the United States of America (USA), Canada, Europe, and Australia.The maximum duration of a subject's trial participation is 30 weeks. The Participant Flow refers to the Safety Set (SS) population which consists of all patients who received at least one dose of study medication.
Pre-assignment details
Subjects were randomized 3:1 to one of two therapeutic doses of Lacosamide, 400 mg/day or 300 mg/day, to ensure a study design comparable to the historical control.
Participants by arm
| Arm | Count |
|---|---|
| Lacosamide 300 mg/Day Lacosamide 300 mg/day
Lacosamide : 50 mg and 100 mg tablets provided for 150 mg twice daily dosing for up to 20 weeks.
Subjects were randomized 3:1 to one of two therapeutic doses of Lacosamide, 400 mg/day or 300 mg/day, to ensure a study design comparable to the historical control. | 106 |
| Lacosamide 400 mg/Day Lacosamide 400 mg/day
Lacosamide : 50 mg and 100 mg tablets provided for 200 mg twice daily dosing for up to 20 weeks.
Subjects were randomized 3:1 to one of two therapeutic doses of Lacosamide, 400 mg/day or 300 mg/day, to ensure a study design comparable to the historical control. | 319 |
| Total | 425 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 16 | 56 |
| Overall Study | Lack of Efficacy | 11 | 30 |
| Overall Study | Lost to Follow-up | 4 | 4 |
| Overall Study | Other reasons for premature termination | 0 | 6 |
| Overall Study | Protocol Violation | 2 | 15 |
| Overall Study | Unsatisfactory compliance of subject | 4 | 3 |
| Overall Study | Withdrawal by Subject | 0 | 11 |
Baseline characteristics
| Characteristic | Lacosamide 300 mg/Day | Lacosamide 400 mg/Day | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 3 Participants | 7 Participants | 10 Participants |
| Age, Categorical >=65 years | 4 Participants | 9 Participants | 13 Participants |
| Age, Categorical Between 18 and 65 years | 99 Participants | 303 Participants | 402 Participants |
| Age, Continuous | 41.4 years STANDARD_DEVIATION 14.3 | 40.4 years STANDARD_DEVIATION 12.5 | 40.6 years STANDARD_DEVIATION 13 |
| Average Baseline Seizure Frequency per 28 days | 10.10 seizures/28 days STANDARD_DEVIATION 8.82 | 10.22 seizures/28 days STANDARD_DEVIATION 8.88 | 10.19 seizures/28 days STANDARD_DEVIATION 8.86 |
| Body Mass Index (BMI) | 28.22 kg/m^2 STANDARD_DEVIATION 5.74 | 28.67 kg/m^2 STANDARD_DEVIATION 6.64 | 28.56 kg/m^2 STANDARD_DEVIATION 6.42 |
| Height | 169.72 centimeter STANDARD_DEVIATION 10.69 | 169.01 centimeter STANDARD_DEVIATION 10.87 | 169.19 centimeter STANDARD_DEVIATION 10.82 |
| Race/Ethnicity, Customized Asian | 0 participants | 1 participants | 1 participants |
| Race/Ethnicity, Customized Black | 9 participants | 53 participants | 62 participants |
| Race/Ethnicity, Customized Other | 6 participants | 19 participants | 25 participants |
| Race/Ethnicity, Customized White | 91 participants | 246 participants | 337 participants |
| Sex: Female, Male Female | 50 Participants | 169 Participants | 219 Participants |
| Sex: Female, Male Male | 56 Participants | 150 Participants | 206 Participants |
| Weight | 81.62 kilogram STANDARD_DEVIATION 19.53 | 82.13 kilogram STANDARD_DEVIATION 21.3 | 82.00 kilogram STANDARD_DEVIATION 20.85 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 74 / 106 | 215 / 319 |
| serious Total, serious adverse events | 4 / 106 | 21 / 319 |
Outcome results
Percentage of Subjects (Using Kaplan-Meier) Who Are Identified As Meeting At Least 1 Pre-defined Exit Criteria By Day 112 Relative To The Start of Withdrawal of Background Antiepileptic Drug(s)
Pre-defined exit criteria: 1. A 2-fold or greater increase in average monthly (28-day) partial seizure frequency (motor and non-motor) compared to average monthly partial seizure frequency (motor and non-motor) during the Baseline Phase 2. A 2-fold or greater increase in consecutive 2-day partial seizure frequency (motor and non-motor) versus the highest consecutive 2-day partial seizure frequency (motor and non-motor) that occurred during the Baseline Phase. Note: if the highest consecutive 2-day partial seizure frequency during the Baseline Phase is 1, a 2-day partial seizure frequency of ≥3 is required to meet this exit criterion 3. Occurrence of a single generalized tonic-clonic seizure if none had occurred in the 6 months prior to randomization 4. A prolongation or worsening of overall seizure duration, frequency, type or pattern considered by the investigator as serious enough to warrant trial discontinuation 5. Status epilepticus, or new onset of serial/cluster seizures
Time frame: 16 Weeks Maintenance Period (approximately 112 days)
Population: The Analysis Population refers to the Full Analysis Set (FAS). The FAS included subjects who completed the Titration Phase and started withdrawing background Anti-epileptic Drugs (AEDs) (ie, entered the Maintenance Phase and took at least 1 dose of Maintenance medication).~The primary analysis is only conducted on the Lacosamide 400 mg/day group.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Lacosamide 400 mg/Day | Percentage of Subjects (Using Kaplan-Meier) Who Are Identified As Meeting At Least 1 Pre-defined Exit Criteria By Day 112 Relative To The Start of Withdrawal of Background Antiepileptic Drug(s) | 30.0 percentage of subjects |
Clinical Global Impression of Change (CGIC) From Baseline To Last Visit
For the assessment of the Clinical Global Impression of Change (CGIC), the investigator should provide his/her assessment of the subject's clinical status, compared to Baseline, including an evaluation of seizure frequency and intensity, the occurrence of AEs, and subject's functional status. He was asked the following:Please check the number that best describes the subject's condition over the past 4 weeks compared to Baseline: 1. Very much improved 2. Much improved 3. Minimally improved 4. No change 5. Minimally worse 6. Much worse 7. Very much worse
Time frame: Baseline; Last Visit (approximately 27 weeks)
Population: The Analysis Population refers to the Full Analysis Set (FAS). The FAS included subjects who completed the Titration Phase and started withdrawing background Anti-epileptic Drugs (AEDs) (eg, entered the Maintenance Phase and took at least 1 dose of Maintenance medication).
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Lacosamide 300 mg/Day | Clinical Global Impression of Change (CGIC) From Baseline To Last Visit | Minimally worse | 6 participants |
| Lacosamide 300 mg/Day | Clinical Global Impression of Change (CGIC) From Baseline To Last Visit | Minimally improved | 18 participants |
| Lacosamide 300 mg/Day | Clinical Global Impression of Change (CGIC) From Baseline To Last Visit | Much worse | 8 participants |
| Lacosamide 300 mg/Day | Clinical Global Impression of Change (CGIC) From Baseline To Last Visit | Very much improved | 21 participants |
| Lacosamide 300 mg/Day | Clinical Global Impression of Change (CGIC) From Baseline To Last Visit | Very much worse | 1 participants |
| Lacosamide 300 mg/Day | Clinical Global Impression of Change (CGIC) From Baseline To Last Visit | No change | 8 participants |
| Lacosamide 300 mg/Day | Clinical Global Impression of Change (CGIC) From Baseline To Last Visit | Not done | 4 participants |
| Lacosamide 300 mg/Day | Clinical Global Impression of Change (CGIC) From Baseline To Last Visit | Much improved | 33 participants |
| Lacosamide 400 mg/Day | Clinical Global Impression of Change (CGIC) From Baseline To Last Visit | Not done | 12 participants |
| Lacosamide 400 mg/Day | Clinical Global Impression of Change (CGIC) From Baseline To Last Visit | Very much improved | 56 participants |
| Lacosamide 400 mg/Day | Clinical Global Impression of Change (CGIC) From Baseline To Last Visit | Minimally improved | 42 participants |
| Lacosamide 400 mg/Day | Clinical Global Impression of Change (CGIC) From Baseline To Last Visit | No change | 18 participants |
| Lacosamide 400 mg/Day | Clinical Global Impression of Change (CGIC) From Baseline To Last Visit | Minimally worse | 16 participants |
| Lacosamide 400 mg/Day | Clinical Global Impression of Change (CGIC) From Baseline To Last Visit | Much worse | 23 participants |
| Lacosamide 400 mg/Day | Clinical Global Impression of Change (CGIC) From Baseline To Last Visit | Very much worse | 1 participants |
| Lacosamide 400 mg/Day | Clinical Global Impression of Change (CGIC) From Baseline To Last Visit | Much improved | 116 participants |
Duration of Monotherapy Treatment During the Monotherapy Phase of The Maintenance Period (Visit 9 - Visit 12)
Days on Monotherapy Treatment were defined as the number of days during the Monotherapy Phase when the subject took Lacosamide (LCM) only (ie, the total number of days exposed to LCM during the Monotherapy Phase minus any days where a concomitant or rescue Anti-epileptic Drug (AED) was taken by the subject). The days on Monotherapy Treatment did not need to be consecutive.
Time frame: Visit 9 - Visit 12 (approximately 10 weeks)
Population: The Analysis Population refers to a subset of the Full Analysis Set (FAS). The FAS included subjects who completed the Titration Phase and started withdrawing background Anti-epileptic Drugs (AEDs).This subset of the FAS included subjects who entered the Maintenance Phase but who never achieved Lacosamide (LCM) monotherapy.
| Arm | Measure | Value (MEDIAN) | Dispersion |
|---|---|---|---|
| Lacosamide 300 mg/Day | Duration of Monotherapy Treatment During the Monotherapy Phase of The Maintenance Period (Visit 9 - Visit 12) | 71 days | Full Range 22 |
| Lacosamide 400 mg/Day | Duration of Monotherapy Treatment During the Monotherapy Phase of The Maintenance Period (Visit 9 - Visit 12) | 71 days | Full Range 20.3 |
Patient's Global Impression of Change (PGIC) From Baseline To Last Visit
For the assessment of the Patient's Global Impression of Change, the subject should provide his/her assessment of his/her own clinical status, compared to Baseline, including an evaluation of seizure frequency and intensity, the occurrence of AEs, and subject's functional status.The subject was asked to answer the following: Over the past 4 weeks, how have you felt compared to before you entered this clinical trial? (Please check the number that best describes your condition.) 1. Very much improved 2. Much improved 3. Minimally improved 4. No change 5. Minimally worse 6. Much worse 7. Very much worse
Time frame: Baseline; Last Visit (approximately 27 weeks)
Population: The Analysis Population refers to the Full Analysis Set (FAS). The FAS included subjects who completed the Titration Phase and started withdrawing background Anti-epileptic Drugs (AEDs) (eg, entered the Maintenance Phase and took at least 1 dose of Maintenance medication).
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Lacosamide 300 mg/Day | Patient's Global Impression of Change (PGIC) From Baseline To Last Visit | Very much improved | 24 participants |
| Lacosamide 300 mg/Day | Patient's Global Impression of Change (PGIC) From Baseline To Last Visit | Minimally worse | 3 participants |
| Lacosamide 300 mg/Day | Patient's Global Impression of Change (PGIC) From Baseline To Last Visit | Minimally improved | 15 participants |
| Lacosamide 300 mg/Day | Patient's Global Impression of Change (PGIC) From Baseline To Last Visit | Much worse | 7 participants |
| Lacosamide 300 mg/Day | Patient's Global Impression of Change (PGIC) From Baseline To Last Visit | Much improved | 33 participants |
| Lacosamide 300 mg/Day | Patient's Global Impression of Change (PGIC) From Baseline To Last Visit | Very much worse | 3 participants |
| Lacosamide 300 mg/Day | Patient's Global Impression of Change (PGIC) From Baseline To Last Visit | No change | 10 participants |
| Lacosamide 300 mg/Day | Patient's Global Impression of Change (PGIC) From Baseline To Last Visit | Not done | 4 participants |
| Lacosamide 400 mg/Day | Patient's Global Impression of Change (PGIC) From Baseline To Last Visit | No change | 15 participants |
| Lacosamide 400 mg/Day | Patient's Global Impression of Change (PGIC) From Baseline To Last Visit | Very much improved | 81 participants |
| Lacosamide 400 mg/Day | Patient's Global Impression of Change (PGIC) From Baseline To Last Visit | Much improved | 93 participants |
| Lacosamide 400 mg/Day | Patient's Global Impression of Change (PGIC) From Baseline To Last Visit | Minimally improved | 37 participants |
| Lacosamide 400 mg/Day | Patient's Global Impression of Change (PGIC) From Baseline To Last Visit | Not done | 14 participants |
| Lacosamide 400 mg/Day | Patient's Global Impression of Change (PGIC) From Baseline To Last Visit | Minimally worse | 19 participants |
| Lacosamide 400 mg/Day | Patient's Global Impression of Change (PGIC) From Baseline To Last Visit | Much worse | 22 participants |
| Lacosamide 400 mg/Day | Patient's Global Impression of Change (PGIC) From Baseline To Last Visit | Very much worse | 3 participants |
Percentage of Subjects (Using Kaplan-Meier) Who Are Identified as Meeting at Least 1 Pre-defined Exit Criteria by Day 112, Withdrew Due to Adverse Event (AE) or Withdrew Due to Lack of Efficacy During The Maintenance Period
Subjects were classified as having an exit event if they experienced at least 1 of the following events during the Maintenance Phase as of Day 112: 1. Met at least 1 exit criterion based on the calculations applied for the Primary Efficacy Analysis 2. Withdrawal due to AE with onset during the Maintenance Phase 3. Withdrew prematurely due to lack of efficacy during the Maintenance Phase The date the subject experienced the event was set to the earliest date the subject met an exit criterion or the date of the last Maintenance Phase dose for subjects not meeting an exit criterion but withdrawing due to an AE or lack of efficacy. The secondary analysis is only conducted on the Lacosamide 400 mg/day group.
Time frame: 16 Weeks Maintenance Period (approximately 112 days)
Population: The Analysis Population refers to the Full Analysis Set (FAS). The FAS included subjects who completed the Titration Phase and started withdrawing background Anti-epileptic Drugs (AEDs) (eg, entered the Maintenance Phase and took at least 1 dose of Maintenance medication).
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Lacosamide 400 mg/Day | Percentage of Subjects (Using Kaplan-Meier) Who Are Identified as Meeting at Least 1 Pre-defined Exit Criteria by Day 112, Withdrew Due to Adverse Event (AE) or Withdrew Due to Lack of Efficacy During The Maintenance Period | 32.3 percentage of subjects |
Time to First Occurrence of Any Exit Event During The Maintenance Period
The time to first occurrence (days) of any exit event was estimated using Kaplan-Meier methods and was based on the time from the start of the Maintenance Phase to the earliest date a subject met an exit criterion. Subjects who discontinued during the Maintenance Phase due to non-exit criteria reasons or who completed the Maintenance Phase before 112 days and did not meet an exit criterion were censored as of the last Maintenance Phase dose date. Subjects completing 112 days in the Maintenance Phase were censored as of Day 112.
Time frame: 16 Weeks Maintenance Period (approximately 112 days)
Population: The Analysis Population refers to a subset of the Full Analysis Set (FAS). The FAS included subjects who completed the Titration Phase and started withdrawing background Anti-epileptic Drugs (AEDs). In addition to being a member of FAS, subjects also met at least one of the exit criterion noted under the Primary Outcome Measure.
| Arm | Measure | Value (MEDIAN) | Dispersion |
|---|---|---|---|
| Lacosamide 300 mg/Day | Time to First Occurrence of Any Exit Event During The Maintenance Period | 39 days | Full Range 21.2 |
| Lacosamide 400 mg/Day | Time to First Occurrence of Any Exit Event During The Maintenance Period | 45.0 days | Full Range 24.3 |