Adjunctive retigabine in refractory focal epilepsy: Postmarketing experience at four tertiary epilepsy care centers in Germany

- 195 patients from 4 German epilepsy centers observed from 2011-2015
- Response in 24.6%, seizure freedom in 2.1%, aggravation in 14.9%, no response in 43.1%
- The one-, two-, and three-year retention rates amounted to 31.7%, 7.7%, and 6.8%.
- Adverse events occurred in 76%, mostly CNS-related; 3 possible SUDEP cases.
- Retigabine can improve seizure control but is a drug of reserve.

PurposeRetigabine (RTG, ezogabine) is the first potassium channel-opening anticonvulsant drug approved for adjunctive treatment of focal epilepsies. We report on the postmarketing clinical efficacy, adverse events, and retention rates of RTG in adult patients with refractory focal epilepsy.MethodsClinical features before and during RTG treatment were retrospectively collected from patients treated at four German epilepsy centers in 2011 and 2012.ResultsA total of 195 patients were included. Daily RTG doses ranged from 100 to 1500 mg. Retigabine reduced seizure frequency or severity for 24.6% and led to seizure-freedom in 2.1% of the patients but had no apparent effect in 43.1% of the patients. Seizure aggravation occurred in 14.9%. The one-, two-, and three-year retention rates amounted to 32.6%, 7.2%, and 5.7%, respectively. Adverse events were reported by 76% of the patients and were mostly CNS-related. Blue discolorations were noted in three long-term responders. Three possible SUDEP cases occurred during the observation period, equalling an incidence rate of about 20 per 1000 patient years.ConclusionsOur results are similar to other pivotal trials with respect to the long-term, open-label extensions and recent postmarketing studies. Despite the limitations of the retrospective design, our observational study suggests that RTG leads to good seizure control in a small number of patients with treatment-refractory seizures. However, because of the rather high percentage of patients who experienced significant adverse events, we consider RTG as a drug of reserve.