AES

AES 2024: Lamotrigine poses no higher arrhythmia risk than levetiracetam in observational study

December 13, 2024

Study design: This study utilized a parallel retrospective cohort design, analyzing data from two independent datasets: Medicare claims (2009-2018) in the U.S. (n = 40,554) and the Clinical Practice Research Datalink (CPRD) in the U.K (n = 13,098). Patients newly treated for seizures with either lamotrigine or levetiracetam were included, with no prior antiseizure medication (ASM) use in the preceding year. Primary outcome was the incidence of ventricular tachycardia or fibrillation (VT/VF) over a two-year follow-up period.

Results: After adjusting for demographics and comorbidities, the hazard ratios for VT/VF were 0.73 (95% CI 0.50-1.1) for Medicare and 0.75 (95% CI 0.35-1.59) for CPRD, indicating no significant difference between lamotrigine and levetiracetam. The two-year cumulative incidence of VT/VF was slightly lower for lamotrigine in both datasets, but the differences weren't statistically significant.

Impact on clinical practice: The findings suggest that lamotrigine doesn't significantly increase the risk of serious ventricular arrhythmias compared with levetiracetam, providing reassurance regarding its cardiac safety profile and challenging recent warnings about its potential proarrhythmic effects.

Source:

Terman, S., et al. (2024, December 8). Lamotrigine and Cardiac Conduction Abnormalities: An International Target Trial Approach. Abstract #2.383. Presented at American Epilepsy Society. https://www.aesnet.org/abstractslisting/lamotrigine-and-cardiac-conduction-abnormalities-an-international-target-trial-approach