Long-term effect of antiepileptic drug switch on serum lipids and C-reactive protein.

Authors

• Scott Mintzer
• Rachael Miller
• Krunal Shah
• Inna Chervoneva
• Maromi Nei
• Christopher Skidmore
• Michael R Sperling

Publication/Presentation Date

5-1-2016

Abstract

BACKGROUND: Prior studies have shown that switching patients from inducing antiepileptic drugs (AEDs) to lamotrigine, levetiracetam, or topiramate reduces serum lipids and C-reactive protein (CRP). These studies were all of short duration, and some drugs, such as zonisamide, have not been investigated.

METHODS: We recruited 41 patients taking phenytoin or carbamazepine who were being switched to zonisamide, lamotrigine, or levetiracetam. We measured serum lipids and CRP before the switch, >6weeks after, and >6months after. An untreated control group (n=14) underwent similar measurement. We combined these data with those of our previous investigation (n=34 patients and 16 controls) of a very similar design.

RESULTS: There were no differences in outcome measures between the two inducing AEDs nor among the three noninducing AEDs. Total cholesterol (TC), atherogenic lipids, and CRP were higher under inducer treatment than in controls. All measures were elevated under inducer treatment relative to noninducer treatment, including TC (24mg/dL higher, 95% CI: 17.5-29.9, p< 0.001) and CRP (72% higher, 95% CI: 41%-111%, p< 0.001). The difference between drug treatments was clinically meaningful for atherogenic lipids (16%, 95% CI: 11%-20%, p< 0.001) but small for high-density lipoprotein cholesterol (5%, 95% CI: 1%-9%, p< 0.05). All measures were stable between 6weeks and 6months after drug switch.

CONCLUSIONS: We demonstrate that switching from inducing to noninducing AEDs produces an enduring reduction in serum lipids and CRP. These results provide further evidence that inducing AEDs may be associated with elevated vascular disease risk. These are the first vascular risk marker data in patients taking zonisamide, which shows a profile similar to that of other noninducing AEDs.

Volume

58

First Page

127

Last Page

132

ISSN

1525-5069

Published In/Presented At

Mintzer, S., Miller, R., Shah, K., Chervoneva, I., Nei, M., Skidmore, C., & Sperling, M. R. (2016). Long-term effect of antiepileptic drug switch on serum lipids and C-reactive protein. Epilepsy & behavior : E&B, 58, 127–132. https://doi.org/10.1016/j.yebeh.2016.02.023

Disciplines

Medicine and Health Sciences

PubMedID

27074299

Department(s)

Department of Medicine

Document Type

Article