Efficacy and safety of adjunctive lacosamide for the treatment of partial-onset seizures in Chinese and Japanese adults: A randomized, double-blind, placebo-controlled study

To evaluate the efficacy and safety of adjunctive lacosamide treatment in Chinese and Japanese adults with uncontrolled focal (partial-onset) seizures (POS), with or without secondary generalization. A 24-week, randomized, double-blind, placebo-controlled study (EP0008; NCT01710657) was conducted in patients (aged 16–70 years) with uncontrolled POS and taking 1–3 concomitant antiepileptic drugs from 72 sites across China and Japan. Following an 8-week Baseline period, randomized patients received lacosamide 200 mg/day (100 mg twice daily), 400 mg/day (200 mg twice daily), or placebo for 4-week Titration and 12-week Maintenance periods. The primary efficacy variable was the change in POS frequency per 28 days from Baseline to Maintenance. Overall, 692 patients were screened; 548 were randomized to placebo (n = 184), lacosamide 200 mg/day (n = 183), or lacosamide 400 mg/day (n = 181); 485 (88.5%) completed the study. The median change (range) in POS frequency per 28 days from Baseline to Maintenance was −3.33 (−754.3 to 165.2), −4.50 (−97.5 to 28.2), and −1.22 (−93.0 to 39.8) in the lacosamide 200 mg/day, 400 mg/day, and placebo groups, respectively. Significant percentage reductions in POS frequency over placebo per 28 days from Baseline to Maintenance were observed for lacosamide 200 mg/day (29.4% [95% CI 18.7–38.7%], p < 0.001) and 400 mg/day (39.6% [30.5–47.6%], p < 0.001). Higher ≥50% and ≥75% responder and seizure freedom rates were observed in lacosamide-treated patients vs placebo. Treatment-emergent adverse events reported by ≥10% of all lacosamide-treated patients occurring at ≥2% difference compared with placebo were dizziness (25.9% vs 9.2%) and somnolence (10.2% vs 3.8%). Dose-proportional pharmacokinetics were consistent with earlier global pivotal trials. Adjunctive lacosamide (200 and 400 mg/day) was efficacious in reducing POS frequency in Chinese and Japanese patients with a safety and tolerability profile consistent with the three global pivotal studies.