The number of Anti-epileptic drugs (AEDs) has more than doubled in the past two decades, and several more medications are in development and expected to be on the market in the next three years. More choices in medication have resulted in fewer side effects, but that is not always the case when generics are introduced. Many of the new and emerging AEDs were outlined during the annual Epilepsy Pipeline Conference hosted by the Epilepsy Therapy Project.
Nine AEDs that were recently approved or are in the late stages of testing and nearing final submission for approval by the Food and Drug Administration (FDA) were discussed at the conference. Those included the recently approved Banzel, Lyrica, Sabril and Vimpat, as well as the following AEDs:
- Eslicarbazepine – A sodium channel blocker related to carbamezipine (Tegretol) in phase 3 testing is applicable for partial onset seizures
- Retigabine – A potassium channel opener for partial onset seizures currently under the final stages of FDA approval for release
- Brivaracetam – Currently in phase 3 testing for adults with partial onset seizures
- Carisbamate – Currently in phase 3 testing, unknown mechanism of action (since the conference, this drug development has been discontinued)
- New Diazepam – The next generation of the auto-injector is in phase 3 testing
- Parampanel – Currently being tested in 3 simultaneous studies
- Clobazam – Approved for Lennox-Gastaut syndrome in other countries
While the new drugs show promise to patients working to get seizures under control, the introduction of generic versions of AEDs have led to new issues in this population. For example, in 2009, the FDA approved generic versions of Keppra. Many insurance companies instructed pharmacists to substitute Keppra with a less expensive generic version. In many cases, patients were not informed of the formulation switching. Patients who had their seizures controlled with Keppra soon experienced a return of seizures while taking the generic Keppra. This growing problem has become one of the Epilepsy Foundation’s advocacy issues.