Study on the Treatment of Elderly Patients With Older and Newer Antiepileptic Drugs (STEP-ONE)

January 24, 2013 updated by: Konrad J. Werhahn, Johannes Gutenberg University Mainz

A Multicentre, Double-blind, Randomized, Phase IV Clinical Trial Comparing the Safety, Tolerability and Efficacy of Levetiracetam Versus Lamotrigine and Carbamazepine in the Oral Antiepileptic Therapy of Newly Diagnosed Elderly Patients With Focal Epilepsy.

In this clinical trial patients with newly diagnosed focal epilepsy aged 60 years or older receive three different antiepileptic drugs in a double-blind, randomized design over a period of 58 weeks. All drugs are licensed for the treatment of epilepsy. The primary endpoint of this study will be retention rate at 58-weeks, since it reflects both efficacy and tolerability.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Indication: Focal Epilepsy Objectives: To evaluate the tolerability and efficacy of levetiracetam (LEV) in newly diagnosed elderly patients (aged 60 yrs or above) with focal epilepsy compared to lamotrigine (LTG) or carbamazepine slow release (CBZ).

Primary Outcome: The primary outcome will be the 58-week retention rate measured by the number of drop outs due to adverse events or seizures from day 1 of treatment.

Secondary Outcome: Proportion of patients remaining seizure-free at week 30 (Visit 4); proportion of patients remaining seizure free at week 58 (Visit 6); the time (in days) to first break-through seizure (from day 1 of treatment); the absolute seizure frequency during the maintenance (over 52 weeks) phase; proportion of seizure-free days during the maintenance phase for subjects who enter the maintenance phase; the frequency of adverse events (from day 1 of treatment); QOLIE-31 results at V6; Portland Neurotoxicity scale at V6; results of cognitive testing (EpiTrack© by UCB).

Trial Design: This is a randomized, double-blind, multicenter Phase IV study using a parallel group design with three treatment groups. The study will consist of a 6-week titration-phase and a 52-week maintenance phase. Patients who successfully complete the trial (final visit, V6) will be unblinded and offered either to continue on their current drug or be changed to an alternative antiepileptic drug (AED) treatment of choice.

Population: Patients aged 60 years or above with new onset focal epilepsy i.e. either at least one epileptic seizure in the last 6 months and focal epileptiform discharges on EEG or a relevant lesion on CT/MRI or a total of 2 epileptic seizures, one of which occurring in the last 6 months prior inclusion. Patients with acute (< 2 weeks) symptomatic epileptic seizures due to acute brain abnormalities (i.e. haemorrhage or cerebral infarct), or contraindications against any of the drugs in trial will be excluded.

Sample Size: 360 patients to be included, 120 patients per treatment arm. Investigational Medicinal Product(s): Levetiracetam, lamotrigine, carbamazepine-slow release Trial Duration and Dates: Duration of treatment: 6 weeks titration phase, 52 weeks maintenance phase.

Follow up: At the end of trial subjects will be unblinded and may choose to continue on the medication or taper the trial medication and be treated with an alternative drug at the investigators discretion. The patient will receive a dosing schedule and a referral letter for his/her physician.

Duration of trial: approximately 2 years. Start of recruitment: January 2007 Projected number of centres: 75 Number of countries: 3 (Germany, Switzerland, Austria).

Study Type

Interventional

Enrollment (Actual)

361

Phase

  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Germany
      • Mainz, Germany, 55101
        • Department of Neurology, University of Mainz Medical Centre

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

58 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Age 60 yrs or above.
  • New onset focal epilepsy i.e. either at least one epileptic seizure in the last 6 months and focal epileptiform discharges on EEG or a relevant lesion on CT/MRI or at least 2 epileptic seizures, one of which occurring in the last 6 months prior inclusion.
  • No previous AED treatment, except for a period not longer than 4 weeks prior to inclusion (V0).
  • Ability of subject to understand verbal and written instructions, to comply with all study requirements, and to comprehend character and individual consequences of the clinical trial.
  • Written informed consent before enrolment in the trial.

Exclusion Criteria:

  • Acute symptomatic epileptic seizures occurring acutely within a 2 week period after the onset of an acute illness such as cerebral haemorrhage, cerebral infarct, rapid progressive malignancy or other acute brain abnormalities (i.e. encephalitis, hypoxic brain damage, trauma, metabolic derangement, following brain surgery).
  • Dementia (as defined by history)
  • Renal insufficiency as defined by GFR < 50 mL/min.
  • Increased liver enzymes (GOT, GPT, gGT) or increased bilirubin ≥ 2-fold the upper limit of normal (ULN).
  • Pre-treatment with valproic acid within the four weeks prior inclusion (V0).
  • Contraindication against or history of hypersensitivity to any of the investigational medicinal products or to any drug with similar chemical structure or to any excipient present in the pharmaceutical form of the investigational medicinal products.
  • Participation in other clinical trials and observation period of competing trials within the last 2 months, respectively.
  • History of drug or alcohol abuse within the last 2 years.
  • Medical condition which interferes with the participation in the trial according to the opinion of the investigator.
  • Patients with life expectancy < 1 year due to malignant disease
  • Psychiatric morbidity requiring legal guardianship.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Levetiracetam
Drug: Levetiracetam
LEV 250 mg capusles: week 1 and 2 0-0-1, week 3 and 4 1-0-1, week 5: 1-0-2, week 6: 2-0-2. Patients may take 2 to 12 per day (500 - 3000 mg)during maintenance.
Active Comparator: Carbamazepine
Drug: Carbamazepine
CBZ 100 mg capusles: week 1 and 2: 0-0-1, week 3 and 4: 1-0-1, week 5: 1-0-2, week 6: 2-0-2. Patients may take 2 to 12 per day (200 - 1200 mg) during maintenance depending on tolerance and efficacy.
Active Comparator: Lamotrigine
Drug: Lamotrigine
LTG 25 mg encapsulated: week 1 and 2: 0-0-1, week 3 and 4: 1-0-1, week 5: 1-0-2, week 6: 2-0-2. Patients may take 2 to 12 caps. per day (50 - 300 mg)during maintenance depending on tolerance and efficacy.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
58-week Retention Rate Measured by the Number of Drop Outs Due to Adverse Events or Seizures From Day 1 of Treatment
Time Frame: 58 weeks
58 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Time to Drop Out
Time Frame: 58 weeks
number of days between randomization and premature discontinuation of the study
58 weeks
Percentage of Patients Remaining Seizure-free at Week 30 (Visit 4)
Time Frame: Week 30
Percentage of patients experiencing no seizures until week 30 (Visit 4) and did not discontinue the study until week 30.
Week 30
Percentage of Patients Remaining Seizure Free at Week 58 (Visit 6)
Time Frame: week 58
Percentage of patients experiencing no seizures until week 58 (Visit 6) and did not discontinue the study until week 58.
week 58
The Time (in Days) to First Break-through Seizure (From Day 1 of Treatment)
Time Frame: over the whole duration of 58 weeks
over the whole duration of 58 weeks
The Absolute Seizure Frequency During the Maintenance Phase (Weeks 7 - 58)
Time Frame: over 52 weeks

Seizure frequency was assessed by investigators in the CRF at the Visits V3, V4, V5 and V6.

The absolute seizure frequency during the maintenance phase was defined as the sum of those entries.
over 52 weeks
Proportion of Seizure-free Days During the Maintenance Phase for Subjects Who Enter the Maintenance Phase
Time Frame: 52 weeks
52 weeks
QOLIE-31 (Quality Of Life In Epilepsy) Results at V6
Time Frame: 58 weeks, final visit
The QOLIE-31 is a 31 item score that measures the quality of life in epilepsy (each item with a range of 0 to 100). There are 7 sub-scores seizure worry (items 11,21,22,23,25), overall quality of life (items 1,14), emotional well-being (items 3,4,5,7,9), energy/fatigue (items 2,6,8,10), cognitive functioning (items 12,15,16,17,18,26), medication effects (items 24,29,30) and social functioning (13,19,20,27,28). These scores were combined to a total score by Total score = seizure worry*0.08 + overall quality of life*0.14 + emotional well-being*0.15 + energy/fatigue*0.12 + cognitive functioning*0.27 + medication effects*0.03 + social functioning*0.21 For all scores, higher values indicate better quality of life. Each score has a possible range from 0 to 100.
58 weeks, final visit
Portland Neurotoxicity Scale (PNS) at V6
Time Frame: at week 58

The PNS is a 15-item scale. Each item can be scored from 1 to 9. There are a total score (includes all items, range:15 to 135) and two subscores: The cognitive toxicity subscore (10 items: Energy Level, Memory, Interest, Concentration, Forgetfulness, Sleepliness, Moodiness, Alertness, Attention Span, Motivation, range:10 to 90) and the somatomoto subscore (5 items: Vision, Walking, Coordination, Tremor, Speech, range:5-45). The score is calculated by taking the mean of all non-missing values times the number of items.

Lower values indicate better quality of life.
at week 58
Results of Cognitive Testing (EpiTrack© by UCB) - Score at V6
Time Frame: week 58
EPITrack-Score shows the performance of attention and executive functions. Higher values indicate a better performance. The results of EPITrack Score ranges between 7 and 45.
week 58
Results of Cognitive Testing (EpiTrack© by UCB) - Categories at V6
Time Frame: 58 weeks

Evaluation of current testing at V6:

≥29 score points: Inconspicuous; 26 to 28 score points: Borderline;

≤25 score points: Impaired
58 weeks
Results of Cognitive Testing (EpiTrack© by UCB) - Changes to Baseline (V0) at Week 58 (V6)
Time Frame: week 58

Evaluation of Changes

Changes in the EpiTrack® Score were categorized as follows:

≥5 score points: Improved;

-3 to 4 score points: Unchanged;

≤-4 score points: Worsened
week 58

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Johannes Gutenberg University Mainz

Collaborators

UCB Pharma GmbH

Investigators

  • Study Chair: Konrad J Werhahn, MD, Johannes Gutenberg University, Department od Neurology
  • Study Director: Günter Kraemer, MD, Swiss Epilepy Centre
  • Study Director: Eugen Trinka, MD, Medical University of Salzburg, Department of Neurology, Austria

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

January 1, 2007

Primary Completion (Actual)

July 1, 2010

Study Completion (Actual)

August 1, 2011

Study Registration Dates

First Submitted

February 21, 2007

First Submitted That Met QC Criteria

February 21, 2007

First Posted (Estimate)

February 22, 2007

Study Record Updates

Last Update Posted (Estimate)

February 28, 2013

Last Update Submitted That Met QC Criteria

January 24, 2013

Last Verified

January 1, 2013

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • STEPONE05
  • ISRCTN: 94839639
  • EudraCT Number:2005-003324-19

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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