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First-line levetiracetam versus enzyme-inducing antiseizure medication in glioma patients with epilepsy.

OBJECTIVE
This study aimed to directly compare the effectiveness of first-line monotherapy levetiracetam (LEV) versus enzyme-inducing antiseizure medications (EIASMs) in glioma patients.


METHODS
In this nationwide retrospective observational cohort study grade 2-4 glioma patients were included, with a maximum duration of follow-up of 36 months. Primary outcome was ASM treatment failure for any reason and secondary outcomes were treatment failure due to uncontrolled seizures and due to adverse effects. For estimation of the association between ASM treatment and ASM treatment failure, multivariable cause-specific cox proportional hazard models were estimated, adjusting for potential confounders.


RESULTS
In the original cohort a total of 808 brain tumour patients with epilepsy were included, of which 109 glioma patients were prescribed first-line LEV and 183 glioma patients first-line EIASMs. The EIASMs group had a significantly higher risk of treatment failure for any reason compared to LEV (adjusted hazard ratio [aHR]=1.82 [95%CI=1.20-2.75], p=0.005). Treatment failure due to uncontrolled seizures did not differ significantly between EIASMs and LEV (aHR=1.32 [95%CI=0.78-2.25], p=0.300), but treatment failure due to adverse effects differed significantly (aHR=4.87 [95%CI=1.89-12.55], p=0.001).


SIGNIFICANCE
In this study it was demonstrated that LEV had a significantly better effectiveness (i.e. less often ASM treatment failure for any reason or due to adverse effects) compared to EIASMs, supporting the current neuro-oncology guideline recommendations to avoid EIASMs in glioma patients.