- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03689114
Low vs. Standard Daily Doses of Antiepileptic Drugs in Newly Diagnosed, Previously Untreated Epilepsy(STANDLOW) (STANDLOW)
March 11, 2024 updated by: Mario Negri Institute for Pharmacological Research
Efficacy and Tolerability of Low vs. Standard Daily Doses of Antiepileptic Drugs in Newly Diagnosed, Previously Untreated Epilepsy (STANDLOW). A Multicenter, Randomized, Single-blind, Parallel-group Trial
There are no guidelines on the first maintenance daily dose of antiepileptic drugs (AEDs) in newly diagnosed, previously untreated epilepsy.
Original trials and Cochrane reviews show that seizure remission can be achieved with differing daily doses.
In clinical practice, the first maintenance dose varies significantly.
In contrast, the risk of adverse treatment effects increases with dosage.
There is thus the need to identify the lowest effective dose for treatment start.
This background prompted us to undertake a randomized multicenter pragmatic non-inferiority trial comparing standard to low daily doses of AEDs to demonstrate that low doses are at least as effective as standard doses (as indicated by the national formulary) but are better tolerated and are associated with a better quality of life.
If proven as effective as the standard dose, a low daily dose of AEDs is a benefit to the patient in terms of tolerability and safety and a source of savings for the National Health System.
Study Overview
Status
Active, not recruiting
Conditions
Intervention / Treatment
- Drug: Low dose carbamazepine
- Drug: Low dose levetiracetam
- Drug: Low dose valproate
- Drug: Low dose zonisamide
- Drug: Low dose oxcarbazepine
- Drug: Low dose topiramate
- Drug: Low dose lamotrigine
- Drug: Low dose gabapentin
- Drug: Standard dose carbamazepine
- Drug: Standard dose levetiracetam
- Drug: Standard dose valproate
- Drug: Standard dose zonisamide
- Drug: Standard dose oxcarbazepine
- Drug: Standard dose topiramate
- Drug: Standard dose lamotrigine
- Drug: Standard dose gabapentin
Study Type
Interventional
Enrollment (Estimated)
374
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 Contact
- Name: Ettore Beghi, MD
- Phone Number: 0239014542
- Email: ettore.beghi@marionegri.it
Study Contact Backup
- Name: Giorgia Giussani, PhD
- Phone Number: 0239014604
- Email: giorgia.giussani@marionegri.it
Study Locations
-
-
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Monza, Italy, 20900
- ASST Monza Ospedale San Gerardo
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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
16 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Age 18 years or older;
- Newly diagnosed previously untreated epilepsy, defined according to the ILAE definition (Fisher et al, 2014);
- Having experienced focal seizures, defined according to the ILAE criteria (Commission, 1981);
- Able to understand and comply with the study requirements and release a written informed consent.
Exclusion Criteria:
A patient will be excluded if at least one of the following criteria will be met:
- Age less than 18 years;
- Having experienced primarily or secondarily generalized tonic and/or clonic seizures, or other (non-focal) seizure types;
- Previous exposure to AEDs;
- Requiring low or standard doses on account of individual needs;
- Inability to understand the aims or modalities of the study;
- Current pregnancy or planning to become pregnant during the study period (e.g. who are not post-menopausal, surgically sterile, or using inadequate birth control). A postmenopausal state is defined as no menses for 12 months without an alternative medical cause;
- Previous treatment with an antiepileptic drug;
- Men unable to practice contraception for the duration of the treatment.
- Poor compliance with assigned treatments;
- Refusal to release written informed consent;
- The study investigators will receive the summary of product characteristics (SPC) available for each study drug. Patients cannot be enrolled in the study if the contraindications/warnings described in the SPC are met.
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: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Low dose
Dosage is in mg: low dose carbamazepine, 300 ; low dose levetiracetam, 500; low dose valproate, 300; low dose zonisamide, 150; low dose oxcarbazepine, 600; low dose topiramate, 100; low dose lamotrigine, 100; low dose gabapentin, 450.
Study drugs are in form of tablets for daily administration.
Study drug administration duration is 12 months.
The choice of the drug is left to the caring physician's discretion but it must be limited to the AEDs marketed for monotherapy use.
All the study drugs will be used according to the respective SPCs, which will be sent by the promoter to all the study investigators.
|
Carbamazepine, 300 mg/die
Other Names:
Levetiracetam 500 mg/die
Other Names:
Valproate 300 mg/die
Other Names:
Zonisamide 150 mg/die
Other Names:
Oxcarbazepine 600 mg/die
Other Names:
Topiramate 100 mg/die
Other Names:
Lamotrigine 100 mg/die
Other Names:
Gabapentin 450 mg/die
Other Names:
|
Active Comparator: Standard dose
Dosage is in mg: standard dose carbamazepine 600; standard dose levetiracetam 1000; standard dose valproate, 600; standard dose zonisamide 300; standard dose oxcarbazepine 1200; standard dose topiramate, 200; standard dose lamotrigine, 200; standard dose gabapentin 900.
Study drugs are in form of tablets for daily administration.
Study drug administration duration is 12 months.
The choice of the drug is left to the caring physician's discretion but it must be limited to the AEDs marketed for monotherapy use.
All the study drugs will be used according to the respective SPCs, which will be sent by the promoter to all the study investigators.
|
Carbamazepine 600 mg/die
Other Names:
Levetiracetam 1000 mg/die
Other Names:
Valproate 600 mg/die
Other Names:
Zonisamide 300 mg/die
Other Names:
Oxcarbazepine 1200 mg/die
Other Names:
Topiramate 200 mg/die
Other Names:
Lamotrigine 200 mg/die
Other Names:
Gabapentin 900 mg/die
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Treatment failure
Time Frame: 12 months
|
The proportion of patients experiencing a treatment failure motivated by the need to change the assigned dose or the assigned drug for seizure relapse during the follow-up.
|
12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Drug-related adverse events
Time Frame: 12 months
|
the proportion of patients experiencing a treatment failure motivated by intolerable drug-related adverse events during the follow-up;
|
12 months
|
Quality of life in epilepsy scale 31 items(QOLIE-31), italian version
Time Frame: 12 months
|
QOLIE-31 total score at baseline and last visit.
Maximum total score is 100 (best quality of life possible) and the minimum is 0 (worst quality of life possible).
|
12 months
|
Patients health care's satisfaction (PSQ-18) scale, 18 items
Time Frame: 12 months
|
The score of the seven PSQ-18 subscales (general satisfaction, technical quality, interpersonal manner, communication, financial aspects, time spent with doctor, accessibility and convenience) at baseline and last visit.
Possible scores of each subscale range from 1 (worst satisfaction) to 5 (better satisfaction).
There is no total score for this scale.
|
12 months
|
Health care resources utilization.
Time Frame: 12 months
|
The mean daily patient's cost of health care resources consumed for the management of epilepsy during the first 12 months of the study.
|
12 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Ettore Beghi, MD, Istituto di Ricerche Farmacologiche Mario Negri IRCCS
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
- Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, Engel J Jr, Forsgren L, French JA, Glynn M, Hesdorffer DC, Lee BI, Mathern GW, Moshe SL, Perucca E, Scheffer IE, Tomson T, Watanabe M, Wiebe S. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014 Apr;55(4):475-82. doi: 10.1111/epi.12550. Epub 2014 Apr 14.
- Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy. Epilepsia. 1981 Aug;22(4):489-501. doi: 10.1111/j.1528-1157.1981.tb06159.x. No abstract available.
- Abimbola S, Martiniuk AL, Hackett ML, Anderson CS. The influence of design and definition on the proportion of general epilepsy cohorts with remission and intractability. Neuroepidemiology. 2011;36(3):204-12. doi: 10.1159/000327497. Epub 2011 May 24.
- Beghi E, Niero M, Roncolato M. Validity and reliability of the Italian version of the Quality-of-Life in Epilepsy Inventory (QOLIE-31). Seizure. 2005 Oct;14(7):452-8. doi: 10.1016/j.seizure.2005.07.008. Epub 2005 Aug 10.
- Gilliam F. Optimizing health outcomes in active epilepsy. Neurology. 2002 Apr 23;58(8 Suppl 5):S9-20. doi: 10.1212/wnl.58.8_suppl_5.s9.
- Maguire M, Marson AG, Ramaratnam S. Epilepsy (partial). BMJ Clin Evid. 2010 Jun 28;2010:1214.
- Perucca P, Jacoby A, Marson AG, Baker GA, Lane S, Benn EK, Thurman DJ, Hauser WA, Gilliam FG, Hesdorffer DC. Adverse antiepileptic drug effects in new-onset seizures: a case-control study. Neurology. 2011 Jan 18;76(3):273-9. doi: 10.1212/WNL.0b013e318207b073.
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 (Actual)
May 10, 2021
Primary Completion (Estimated)
June 30, 2024
Study Completion (Estimated)
August 31, 2024
Study Registration Dates
First Submitted
September 27, 2018
First Submitted That Met QC Criteria
September 27, 2018
First Posted (Actual)
September 28, 2018
Study Record Updates
Last Update Posted (Actual)
March 12, 2024
Last Update Submitted That Met QC Criteria
March 11, 2024
Last Verified
March 1, 2024
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Epilepsy
- Epilepsies, Partial
- Hypoglycemic Agents
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Enzyme Inhibitors
- Analgesics
- Sensory System Agents
- Excitatory Amino Acid Antagonists
- Excitatory Amino Acid Agents
- Analgesics, Non-Narcotic
- Antipsychotic Agents
- Tranquilizing Agents
- Psychotropic Drugs
- Membrane Transport Modulators
- Anti-Anxiety Agents
- GABA Agents
- Voltage-Gated Sodium Channel Blockers
- Sodium Channel Blockers
- Antimanic Agents
- Cytochrome P-450 Enzyme Inducers
- Calcium-Regulating Hormones and Agents
- Calcium Channel Blockers
- Cytochrome P-450 CYP3A Inducers
- Nootropic Agents
- Gabapentin
- Lamotrigine
- Valproic Acid
- Anticonvulsants
- Zonisamide
- Levetiracetam
- Carbamazepine
- Oxcarbazepine
- Topiramate
Other Study ID Numbers
- STANDLOW
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
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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