MONEAD study: Is it safer for expectant mothers to choose these two anti-epileptic drugs? 丨AAN2021

Previous studies have reported that some anti-epilepsy drugs have teratogenic effects, but pregnant women with epilepsy are at risk of seizures if they do not use drugs during pregnancy.

Therefore, it is necessary to choose anti-epileptic drugs that are not teratogenic or have less teratogenic effects during pregnancy.

Recently, a study further demonstrated the safety of two antiepileptic drugs, lamotrigine and levetiracetam, during pregnancy.
The results will be announced at the 2021 American Academy of Neurology (ANN) annual meeting.

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Previous studies have reported that some anti-epilepsy drugs have teratogenic effects, but pregnant women with epilepsy are at risk of seizures if they do not use drugs during pregnancy.

Therefore, it is necessary to choose anti-epileptic drugs that are not teratogenic or have less teratogenic effects during pregnancy.

Recently, a study further demonstrated the safety of two antiepileptic drugs, lamotrigine and levetiracetam, during pregnancy.
The results will be announced at the 2021 American Academy of Neurology (ANN) annual meeting.

Research Introduction The MONEAD study is a prospective, observational, multi-center study funded by the National Institutes of Health.
A total of 289 pregnant women with epilepsy and 89 healthy pregnant women were included.
The blood drug concentration of pregnant women with epilepsy was measured in the third trimester.

In addition, cognitive and developmental tests were conducted at the age of 3 to explore whether the use of lamotrigine and/or levetiracetam during pregnancy in pregnant women with epilepsy affects the neurobehavioral development of the fetus.

 Main findings: ➤ 74% of pregnant women with epilepsy were treated with lamotrigine or levetiracetam alone, 22% of pregnant women with epilepsy were treated with combination therapy, and nearly half of them took lamotrigine combined with levetilag Sitam.

➤ Children born to pregnant women with epilepsy and healthy pregnant women have no difference in language index scores at the age of 3 (mean LS 102.
7 vs.
102.
1).

 ➤ The highest blood drug concentration in the second trimester has nothing to do with the language index score (n = 265; the estimated parameter value after adjustment is -1.
9; 95% CI, -6.
8~3.
1).

However, when the language index score of the main anti-epileptic drug group was analyzed separately, only significant correlation was found with the exposure of levetiracetam (P=0.
028).

There was no difference in the general conceptual ability scores of children born to pregnant women with epilepsy and healthy pregnant women (105.
1 vs.
103.
5).

 ➤The ratio of the maximum blood concentration of anti-epileptic drugs in the third trimester of pregnancy has no significant correlation with the general conceptual ability scores of children born to pregnant women with epilepsy after correction.

 Experts commented on the study’s lead researcher, Dr.
Kimford J.
Meador, said that there are currently more than 30 anti-epileptic drugs, but only a few provide safety data during pregnancy.

The publication of the data of this study will further enhance the confidence in the use of lamotrigine and levetiracetam during pregnancy.

Because, from the main results, the language index and general concept ability scores of children born to epileptic pregnant women using lamotrigine and levetiracetam are no different from those of children born to healthy pregnant women.

In the results of drug exposure doses, no danger signals were found as a whole.
Only a “slight signal” was found when analyzing the data of a single drug.
That is, as the exposure level of levetiracetam increased, the language index score decreased, but There is no difference in general conceptual ability.

 But Dr.
Kimford J.
Meador also said that it is necessary to be cautious about the results this time, because some signals are observed at the age of 2, which are not so obvious at the age of 3; and neurobehavioral testing is also performed on children aged 2-3.
More difficult, more results need to be clear at 6 years old.

 Finally, Kimford J.
Meador suggested that women planning to become pregnant should discuss with their doctors in advance and try to use safer antiepileptic drugs, such as lamotrigine and levetiracetam, and get good control before pregnancy.
Any drugs used during pregnancy should maintain the same blood drug levels.

He also suggested that women should take folic acid regularly, as it has been shown to improve cognitive and behavioral outcomes.

 Reference: More Reassurance for Certain Antiseizure Drugs in Pregnancy-Medscape-Mar 10, 2021.