Keppra: best retention rates

“A recent powerful approach has been to study long-term continuation (retention) rates for new antiepileptic drugs, which can be regarded as a composite measure of adverse events and efficacy over time.”

(Krakow K, Walker M, Otoul C, et al. Neurology 2001;56:1772-1774. 1772 col 1)

In a prospective analysis of 811 patients with chronic epilepsy who received Keppra, the longest duration of follow-up was 41 months and the mean daily dose was 2000 mg

(Depondt C, Yuen AWC, Mula M, et al. Long-term retention and efficacy of levetiracetam in a large cohort of patients with chronic epilepsy. Epilepsia. 2004;45:121.)

Sustained efficasy in long term treatment

Analyzed data from patients treated with Keppra during development stages:
Still treated at cut-off date - 562 / 1422
Retention rate - 40%
Duration of treatment (days)
- Median - 399
- Range - 1 - 2984
Patient-years of exposure - 2421
Starting dose
- Median - 1000 mg/day
- Range - 250-4000 mg/day

long-term efficacy

Responder rate (n=1325)
(reduction of all seizures)
- ³50% 39%
- ³75% 20%
Seizure free (n=1422)
(freedom from all types of seizures)
- at least 6 months 13%
- at least 1 year 8%

Sustained long-term efficacy

long-term treatment reasons for discontinuation

n %

Inherent to clinical trials 374 26
Adverse events 225 16
- Convulsions 48 3.4
- Somnolence 28 2.0
Insufficient treatment control 261 18

The long term retention of levetiracetam in a large cohort of patients with epilepsy

Depondt et al., Journal of Neurology, Neurosurgery, and Psychiatry 2006;77:101-103

ABSTRACT: Levetiracetam (Lev) is a new antiepileptic drug with a distinct mechanism of action, shown in regulatory trials to be effective. These controlled trials do not always predict how useful a drug will be in day to day clinical practice. Retention rates can provide a better indication of efficacy and tolerability in everyday use. Patients attending a tertiary referral centre for epilepsy and who received Lev in the first 2 years of its marketing were assessed (n = 811) to determine continuation rates of treatment with this drug. At the last follow up, 65% of patients were still taking Lev, and the estimated 3 year retention rate was 58%. In total, 11% attained seizure freedom of at least 6 months. Patients taking greater numbers of concurrent antiepileptic drugs (AEDs) were more likely to discontinue Lev, and those reaching higher maximum daily dosages were less likely to discontinue Lev. The retention rate for Lev compares favourably with that of other new AEDs.