Retrospective Multicenter Chart Review Study of Adjunctive Cannabidiol for Seizures Associated with Lennox-Gastaut Syndrome, Dravet Syndrome and Tuberous Sclerosis Complex
Adam Strzelczyk 1, Kerstin Alexandra Klotz 2 3, Thomas Mayer 4, Felix von Podewils 5, Susanne Knake 6, Gerhard Kurlemann 7, Luise Herold 5, Ilka Immisch 6, Elisa Buhleier 8, Felix Rosenow 8, Susanne Schubert-Bast 8 9
- 1Goethe-University Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Medicine Frankfurt, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany. strzelczyk@med.uni-frankfurt.de.
- 2Department of Pediatric Neurology, University Hospital Bonn, Bonn, Germany.
- 3Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
- 4Epilepsy Center Kleinwachau, Radeberg, Germany.
- 5Department of Neurology, Epilepsy Center, University Hospital Greifswald, Greifswald, Germany.
- 6Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg, Germany.
- 7St. Bonifatius Hospital, Lingen, Germany.
- 8Goethe-University Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Medicine Frankfurt, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany.
- 9Goethe-University Frankfurt, University Hospital for Children and Adolescents, Department of Pediatric Epileptology, University Medicine Frankfurt, Frankfurt am Main, Germany.
Affiliationer
Introduction: Effectiveness and tolerability of plant-derived highly purified cannabidiol (CBD) in patients with Lennox-Gastaut syndrome (LGS), Dravet syndrome (DS), or tuberous sclerosis complex (TSC)-associated epilepsy in clinical practice in Germany were evaluated.
Methods: This multicenter, retrospective, chart review study analyzed patients with LGS, DS, or TSC-associated epilepsy receiving ≥ 1 dose of adjunctive CBD (Epidyolex® 100 mg/mL oral solution). Treatment characteristics, seizure outcomes, physician-rated Clinical Global Impression of Change (CGI-C), treatment retention rates, and adverse events (AEs) were analyzed ≤ 12 months.
Results: Among 202 patients identified (159 LGS; 34 DS; 9 TSC), median (interquartile range; range) age was 18.0 (7.9-32.0; 0.3-72.0) years, and median (range) number of prior and concomitant antiseizure medications was 6 (1-24) and 3 (1-7), respectively. Median target CBD dose was 11.1 mg/kg/day (17.6, 15.2, and 9.9 mg/kg/day in the < 6, 6-17, and ≥ 18 years subgroups, respectively). Responder rates (≥ 50% seizure reduction) for total seizures at 3 (n = 194) and 12 (n = 168) months were 43.3% (37.0-50.0% across ages) and 44.0% (37.0-52.5% across ages), respectively, and for generalized tonic-clonic seizures 54.3% (n = 94) (50.0-66.7% across ages) and 47.7% (n = 88) (37.8-66.7% across ages), respectively. Median (range) number of seizure days per month significantly decreased from 30 (0.3-30) to 18 (0-30) in the 3 months before the last 3 months of CBD treatment (p < 0.001). Any improvement in CGI-C was observed in 62% of patients. Of those with available data at 3 and 12 months, 89.6% and 67.1% remained on CBD, respectively. Retention was similar across age groups. AEs reported in ≥ 5% of patients were sedation and diarrhea.
Conclusions: In patients with LGS, DS, or TSC-associated epilepsy, adjunctive CBD was associated with a reduction in seizure frequency across age groups. CBD demonstrated tolerability consistent with its known profile, and 67% of patients remained on treatment at 12 months.
Keywords: Cannabidiol; Clinical Global Impression of Change; Developmental and epileptic encephalopathies; Dravet syndrome; Epilepsy; Lennox–Gastaut syndrome; Responder rate; Tuberous sclerosis complex.
