Eslicarbazepine acetate and carotid intima-media thickness in epileptic patients

Objective: Evaluate if eslicarbazepine acetate (ESL) in combination with other non-inducer antiepileptic drugs (AEDs) in the treatment of epilepsy may represent a positive impact in the cardiovascular risk profile. Methods: multicentre, retrospective, observational, non-interventional, real-life study comparing patients treated with cytochrome P450 (CYP) inducer vs. ESL plus non-inducer AEDs. Primary endpoint: Carotid intimamedia thickness (CIMT) measured following the Manheim Consensus criteria. Results: Patients included: 163. The main demographic, clinical and vascular risk parameters were comparable between the two groups except for duration of the disease, prevalence of dyslipidemia and use of lipid-lowering drugs (significantly higher in the inducers group) and number of previous antiepileptic drugs (significantly higher in the non-inducers group). Bivariate analysis of the main endpoint showed almost significant differences (p = 0.05) in CIMT measures favourable to non-inducers (average 0.617 mm + SD = 0.148) vs. inducers (average 0.663 mm + SD = 0.147). Other variables reaching statistical significance were: age > 50 years (p < 0.001), high blood pressure (p < 0.01) and dyslipidemia (p < 0.05). A multivariate analysis including these variables and biochemical vascular risk factors showed a predictor model including two variables: inducers group (p = 0.031; Coefficient beta = 0.234) and age > 50 years (p = 0.001; Coefficient beta = 0.387). Regarding gender, the mean CIMT in males was significantly higher in the inducers (0.693 mm; SD = 0.139) than in the non-inducers groups (0.628 mm; SD = 0.151; p < 0.05). In females the differences were not significant. Significance: The use of CYP inducer AEDs is associated with a significant increase in CIMT as compared with ESL and other non-inducer AEDs. The study shows a decrease in the vascular risk measured by ultrasound criteria in male patients treated with ESL compared with patients treated with inducer AEDs.