In‐hospital outcomes of lacosamide versus levetiracetam for early adjunctive treatment of status epilepticus: A Nationwide Japanese retrospective cohort study

Abstract Objective Status epilepticus (SE) is a neurological emergency requiring immediate treatment. Although intravenous lacosamide (LCM) is used for the management of epilepsy, its effectiveness in treating SE remains unclear. We aimed to compare the in‐hospital outcomes between intravenous LCM and levetiracetam (LEV) as an early adjunctive therapy for SE using a nationwide inpatient Japanese database. Methods We conducted an observational study using data extracted from the Japanese Diagnosis Procedure Combination database. Patients admitted for SE who received intravenous diazepam or lorazepam on the day of admission and were discharged between April 2019 and March 2023 were enrolled. Patients were categorized into those who received intravenous LCM or LEV on the day of admission. We compared the in‐hospital outcomes (in‐hospital mortality, length of hospital stay, total hospitalization costs, and proportion of patients with a Glasgow Coma Scale score [GCS] ≤9 at discharge) between the groups using propensity score overlap weighting. Results Among the 4605 eligible patients, 227 received LCM and 4378 received LEV . In the propensity score overlap‐weighted cohort, in‐hospital mortality (4.0% vs. 4.6%, adjusted risk difference [ aRD ], −0.28%; 95% confidence interval [ CI ], −3.3% to 2.7%), length of hospital stay (22.4 vs. 22.3 days; difference, 0.011; 95% CI , −3.9 to 3.9), and total hospitalization costs (1 167 798 JPY vs. 1 177 497 JPY ; difference, 9699 JPY ; 95% CI , −196 269 to 176 872 JPY ) did not differ significantly between the LCM and LEV groups. The proportion of patients with GCS scores ≤9 at discharge was lower in the LCM group than in the LEV group (0.6% and 2.4%; aRD , −2.1%; 95% CI , −3.3% to −0.9%). Significance LCM and LEV did not yield significantly different in‐hospital mortality rates when used for early adjunctive treatment of SE. However, LCM may reduce poor neurological status at discharge. These results highlight the potential utility of LCM in the early management of SE. Plain Language Summary This study compared two intravenous antiseizure medications, levetiracetam (LEV) and lacosamide (LCM), as early add‐on therapy for status epilepticus (SE), using data from a large Japanese inpatient database. The in‐hospital mortality, length of hospital stay, or total medical costs did not differ significantly between the groups. However, patients treated with LCM had a lower chance of having a poor neurological status at discharge. While LEV is a well‐established treatment for SE, this study suggests that LCM may be similarly effective and could offer an advantage, although more research is needed.