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Two of the most important things to know when deciding on which med is the best for a particular condition2: how likely is it to work and how long will it take.

The odds of a med working for a particular condition and how long it generally takes to work should be fairly easy to nail down, and not need to be summed up by the Internet shorthand YMMV (Your Mileage May Vary). Aside from it being hard enough to get an accurate diagnosis when brain cooties are involved, why is it so difficult to figure out if Keppra-XR is right for you and how long it will take for you to know that?

  • Because no one is quite sure exactly what causes various conditions.
  • Which is further complicated when everything is a spectrum disorder (e.g. bipolar 1, bipolar 2, all the others planned for DSM-V).
  • And they’re never really sure about how Keppra-XR works in the first place.
  • Plus, if you have more than one condition for which you’re taking one or more medications to treat, things get really complicated.
  • None of which is helped by studies that produce contradictory results, if they aren’t questionable in the first place.3

See our page on the tests researchers use to measure the efficacy of medications, including during clinical trials to get FDA approval.

1.  How Long Until Keppra-XR (levetiracetam) Starts Working1

Not very. Like, as in one-to-two days not very.
Even for refractory epilepsy Keppra can start working in one day.

2.  Likelihood Keppra-XR (levetiracetam) Will Work for its Approved Conditions

As an add-on, or even as monotherapy for epilepsy, the odds of Keppra working are pretty damn good. In the clinical trials and larger studies it averages out to half the people who take it have their seizures reduced by at least 50%, with about 15% becoming seizure-free. Most of them keep taking it after three years and four years. That’s for both immediate-release Keppra and extended-release Keppra XR.
The numbers on how many people discontinued Keppra due to side effects are the lowest we’ve seen in clinical trials for any med. Seriously. Look at this one. 1.8% of people stopped taking Keppra vs. 4.3% who stopped taking the placebo because the side effects of the placebo sucked too much! So it’s no surprise that Keppra improves your general quality of life.

Where Keppra really shines is for people with refractory (otherwise uncontrollable) epilepsy. They’ve done two big-ass, global Safety of Keppra as Adjunctive Therapy in Epilepsy (SKATE) studies on just that. The results:

  • In the first one 50.1% of patients had seizure frequency reduction of >=50%; 15.8% of patients were seizure free;60.4% showed at least moderate improvement.
  • In the second one, much smaller one 44.0% of patients had a >=50% reduction in seizure frequency, and 17.7% became seizure free.

In some of the other studies we found on refractory epilepsies:

  • In an open-label study of Keppra as an add-on in Korean adults with uncontrolled partial epilepsy The median percent reduction in weekly seizure frequency over the treatment period was 43.2%. The >=50% and >=75% responder rates were 45.4% and 36.1%, respectively. 17 out of 92 patients were seizure-free.
  • In this study of people with either partial or generalized epilepsy who were taking two or more other AEDs The 49.4% of people with partial seizures and 51.4% with generalized seizures had a 50% or more reduction in seizure frequency. 26/191 (13.6%) were seizure-free. 10.5% (18/172) were seizure-free for at least 6 months and 6.4% (11/172) were seizure-free for at least 1 year.
  • For refractory generalized epilepsies Most patients (68%) reported some improvement in seizure frequency on levetiracetam including 16% who became seizure free.
  • In a similar small study with 11 patients using only Keppra and 8 taking Keppra and something else, 13 became seizure-free, and 5 achieved a 50–75% reduction in seizure frequency. No change in seizure frequency was observed in 1 patient.
  • Keppra XR as an add-on to one to three AEDs. Thirty-four (43%) Keppra XR and 23 (29.1%) placebo patients experienced >=50% reduction in seizures, with eight (10.1%) taking Keppra XR one (1.3%) getting the placebo becoming seizure-free.
  • One of the most difficult to treat types of epilepsy (or any brain cooties) is when it starts young (childhood onset) and isn’t quickly controlled. In this study of the long-term use of Keppra in severe childhood-onset epilepsy Thirty-five patients (27.1%) were initial responders of which 5 became seizure free. After 3 years was 22.5% kept taking Keppra. Those numbers seem low compared with the above studies, but that’s actually really good for this situation.
  • You know what really, really sucks when you’re epileptic? Having part of your brain cut out to control your seizures (resection), but it doesn’t work. Once again, Keppra to the rescue! 76.1% (16 of 21) had a reduction in seizures, including 10 (47.6%) patients who became seizure free. Although 3 of those 16 developed severe psychoses 4–9 months later, which is a higher rate than people with a history of crazy. But can you blame them?

In the long-term:

  • Following up six months eight years later Keppra (along with whatever else they were taking) was working for 36.1% of people taking it. Of them, 38.6% had at least a 50% reduction in seizures and 20.1% had at least a 75% reduction. Sixty-five (4.6%) patients were seizure-free over their entire treatment period, compared with 167 (11.7%) and 126 (8.9%) during their last 6 and 12 months of follow-up. Ninety-seven (19.8%) of 491 patients who received only one other antiepileptic drug (AED) were seizure-free during their last 6 months. 14.4% (205 patients) reduced the number of meds they took and 5.5% (79 patients) were taking only Keppra.
  • As with vanilla epilepsy, Keppra improves your quality of life.

3.  Likelihood Keppra-XR (levetiracetam) Will Work for Off-Label Applications

You’d think with so many off-label uses of Keppra, this can go on forever! Actually, it’s not easy to get real numbers for off-label applications.

4.  How Keppra-XR (levetiracetam) Compares with Other Meds for its Approved Treatments

Since Keppra is approved only as an add-on, there aren’t many head-to-head studies that focus purely on efficacy. Most are about side effects.

  • Keppra vs. Topamax for long-term treatment of chronic, refractory epilepsies. Two of the best meds for some of the most difficult to treat types of epilepsy. 301 on Keppra and 429 taking Topamax. The results: Keppra sucked less and worked better. After one year was 65.6% of patients were still taking Keppra vs. 51.7% for Topamax-treated patients. At two years it was 45.8% still on Keppra and 38.3% still on Topamax. Adverse events led to drug discontinuation in 21.9% of Topamax-treated patients compared to 6.0% of Keppra-treated patients. The number of patients discontinuing treatment because of lack of efficacy was similar for both groups. Topamax was somewhat better in seizure freedom rates, between 11.6% and 20.0% for Topamax and between 11.1% and 14.3% Keppra LEV per 6-months interval.
  • Keppra vs. Topamax for short-term treatment of refractory partial epilepsy. Keppra wins hands down. 61 patients received Keppra and 61 Topamax. During the 15 days of the study 26 people (42.6%) taking Keppra were seizure free compared to 10 (16.4%) taking Topamax.
  • IV Keppra vs. Diastat for prolonged, repetitive seizures. Distat is like a Valium suppository, except in gel form, so you have to manually rub it around with your finger up in someone’s butthole. In this study they had to do it more than once with each patient. The results: it’s a tie, but they work a lot better together. I think we can guess which method the people in the hospitals prefer.
  • AED geezer cagematch! Tegretol vs. clobazam vs. Neurontin vs. Keppra vs. Lamictal vs. Trileptal vs. Dilantin (phenytoin) vs. Topamax vs. Depakote vs. Zonegran in people 55 or older with a variety of types of epilepsy. The winner: Lamictal, with 79% of people staying on it for one year or longer and 54% seizure-free. Keppra was a close second with 73% staying on it and 43% seizure-free. The same was true even for refractory epilepsy, with 47.4% responding to Lamictal and 38.9% responding to Keppra. The biggest loser: Trileptal, with only 24% staying on and 4% remaining seizure-free.
  • Keppra vs. Tegretol vs. Lamictal. This study investigated the risk factors of cardiovascular disease in patients with epilepsy who take different AEDs. The results: Uh, well, Tegretol kind of made things a little worse, especially with women, who gained weight on it and Lamictal due to inactivity. Tegretol also raised total cholesterol (TC), low-density lipoprotein (LDL) and high-density lipoprotein in both men and women.
  • Keppra vs. Lamictal vs. phenobarbital in people with Alzheimer’s. You know someone is old if they’re taking pheno for epilepsy. The results: a tie! At least when it comes to seizures. Lamictal made them feel better and Keppra helped with the Alzheimer’s symptoms a little, neither of which is surprising.
  • Keppra vs. Lamictal - which one gets you more pissed off? Finally, a useful study! The results: a tie. Both in control of partial seizures and improvement of mood and lessening hostility, Keppra works as well as Lamictal.
  • Along similar lines, Keppra vs. Topamax, which one makes you crazier? The results: Topamax is somewhat more likely to make you crazier, especially if you become seizure-free. How is being seizure-free related to going batshit crazy? The term is “forced normalization.”
  • IV Keppra vs. Dilantin (phenytoin) for seizure prophylaxis after neurological injury. In English: to prevent seizures after something like a traumatic brain injury (TBI). The results: Keppra works a lot better and sucks a lot less than Dilantin (phenytoin), which is the gold standard for TBI-induced epilepsy.
  • Of course someone had to compare the costs of Keppra vs. phenytoin for TBI-induced seizures. That’s where phenytoin wins, at $37 a week vs. $480. Unless you have some good insurance, starting with phenytoin is probably the best way to deal with this.
  • Keppra XR vs. immediate-release Keppra, which sucks less? For a drug with a side effect profile lower than placebo, this is a tough call. The result: no difference, but what can you expect from a study run by the company that makes Keppra? At least the authors question the methodology.
  • Keppra vs. Tegretol. Keppra worked for 78% vs 69% taking Tegretol. But this study was really about the cognitive effects. Which do you think made them less stupid? Executive functions improved in 15% and deteriorated in 5% of patients taking Keppra; the opposite pattern was seen with those taking Tegretol.
  • Now this just isn’t fair. Comparing Keppra with Topamax for cognitive side effects. Really?
  • AED stupidity cagematch! Depakote vs. Dilantin (phenytoin) vs. Keppra vs. Lamictal vs. Neurontin vs. Tegretol vs. Topamax vs. Trileptal vs. Zonegran in which makes you the stoopidedist. The wiener: Stupamax Dopamax Topamax, with 21.5% of people reporting intolerable (where they had to stop taking it) cognitive side effects. In second place was Zonegran with 14.9% and in third place was Trileptal with 11.6%. Keppra scored fairly high with 10.4%, but that includes people who were taking Keppra along with one or more other AEDs. When taking only Keppra it had the fewest (no number in the abstract) number of reported cognitive side effects.
  • Long-term AED tolerability cagematch. Which AED can more people out of 828 stand for two years? Keppra vs. Lamictal vs. Trileptal vs. Topamax vs. Zonegran. The winner: Lamictal with 74.1%, followed by Zonegran with 60.2%, Triletpal? with 58.8%, Keppra with 53.6%, and Topamax with 44.2%. Most were discontinued due to inefficacy (29.5%) and/or sedating (?!) side-effects (20.5%), usually within 6 months. There were the usual drug-specific side effects that caused people to quit as well, like Keppra’s irritability, the Lamictal rash, and the ever-popular kidney stones from Topamax and Zonegran.
  • AED rash cagematch. Tegretol vs. clobazam vs. Felbatol (felbamate) vs. Neurontin vs. Lamictal vs. Keppra vs. Trileptal vs. phenobarbital vs. Dilantin (phenytoin) vs. primidone vs. Gabitril vs. Topamax vs. Sabril (vigabatrin) vs. Depakote vs. Zonegran as to which is most likely to cause rashes. Hmmmm, I wonder which one it could be? And the winner is…Dilantin (phenytoin)! Because this study included people who got rashes from another AED. Some of the numbers: phenytoin 5.9% overall, 25.0% in those with another AED rash, Lamictal 4.8% overall, 14.4% with another AED rash, and Tegretol 3.7% overall, 16.5% with another rash.

5.  How Keppra-XR (levetiracetam) Compares with Other Drugs for Off-Label Treatments

‹ Expanded How to Take and Discontinue | Keppra-XR Index | Expanded Pharmacokinetics & Noted Drug-Drug Interactions ›
Crazy Meds Comprehensive Keppra-XR pages

Bibliography

1 In fancy doctorspeak: Time-to-response, or response time, or response begins at, or something with "response" in it. "Onset" refers to when the symptoms of a condition first appeared (presented). The only time you'd use "onset" with a drug is when side effects are involved.

2 Assuming you were correctly diagnosed in the first place.

3 Keep in mind that according to one study, most drug studies will skew in favor of the med made by the company that sponsored the study.* That's one of my favorite "no shit Sherlock" studies, although it did help in getting conflicts of interest showing up on papers.
Two additional papers along similar lines are Why Current Publication Practices May Distort Science** and Why Most Published Research Findings Are False***. So in addition to the books we use as source material, this is why we also factor a lot of anecdotal evidence (personal experience, experiences of people we know, case reports, what people have sent us in e-mail, and what is posted all over the Internet) into our conclusions regarding the likelihood of meds working, the prevalence of various side effects, etc.
While the drug companies are getting a lot more transparent and publishing more data in the PI sheets regarding the results of the clinical trials, they still don't publish how many times a drug failed a clinical trial.****


Date created Tuesday, 04 October 2011 at 11:12:28 Page Creator: Kassiane S. Last edited by:

Keppra-XR’s Expanded Efficacy and Comparisons with Other Meds is copyright 2011 Kassiane S.

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