Selection of antiseizure medications for first add-on use: A consensus paper.

Introduction: When monotherapy used alone or sequentially fails to achieve seizure control, a trial of combination therapy may be considered.
Objective: To define optimal criteria to guide choice of an antiseizure medication (ASM) for use as first add-on.
Methods: A standardized Delphi procedure was applied to produce a list of consensus statements. First, an Expert Board consisting of 5 epileptologists agreed on a set of 46 statements relevant to the objective. The statements were then finalized through an iterative process by a Delphi Panel of 84 Italian pediatric and adult neurologists with expertise in the management of epilepsy. Panel members provided anonymous ratings of their level of agreement with each statement on a 9-point Likert scale.
Results: Consensus, defined as agreement by at least 80% of Panel members, was reached for 36 statements. Medication-related factors considered to be important for drug selection included efficacy, tolerability and safety, interaction potential, mechanism of action, and ease of use. The need to optimize adherence and to tailor drug selection to individual characteristics was emphasized.
Conclusions: Choice of an ASM for first add-on requires consideration of many factors, many of which also apply to choose initial treatment. Factors more specifically relevant to add-on use include drug interaction potential and the preference for an ASM with a different mechanism of action.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Antonio Gambardella received speaker’s or consultancy fees from Eisai, UCB Pharma and Zogenix. Paolo Tinuper received speaker’s or consultancy fees from Arvelle, Eisai, GW Pharma, LivaNova, UCB Pharma, Xenon Pharma and Zogenix. Benedetto Acone received speaker’s or consultancy fees for projects sponsored by Eisai, Astra Zeneca, Novartis, Gilead, Abbvie, Sanofi, Sandoz, Sobi, MSD, Angelini, AlfaSigma, Janssen, Kyowa Kirin, Abiogen, Amgen, Teva; Giangennaro Coppola received speaker’s or consultant fees from Eisai and Humana; Paolo Bonanni received speaker’s or consultancy fees from Eisai, LivaNova, Lusofarmaco and Proveca; Emiio Perucca received speaker’s or consultancy fees from Arvelle, Biogen, Corlieve, Eisai, GW Pharma, Sanofi, Sun Pharma, UCB Pharma, Xenon Pharma and Zogenix.
(Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)