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FDA accepts historical controls for epilepsy monotherapy studies
Date:7/20/2010

New York University researchers revealed that data from previously completed withdrawal to monotherapy studies for antiepileptic drugs (AEDs) provide a valid control for future studies, obviating the need for placebo/pseudo-placebo trials to demonstrate the efficacy of these drugs as monotherapy. Results of this study are now available online in Epilepsia, a journal published by Wiley-Blackwell on behalf of the International League Against Epilepsy.

According to a National Institute of Neurological Disorders and Stroke workshop, monotherapy is the ultimate treatment strategy for newly-diagnosed and many long-term epilepsy patients because of fewer side effects, better compliance, less risk of fetal malformations (teratogencity) and lower cost compared with polytherapy.

However, in the U.S., it is difficult to get monotherapy approval for AEDs because the FDA, in accordance with the International Conference on Harmonization (ICH), requires an internal, interpretable control group in which the test drug shows superiority over the control. New AEDs, while offering improvements in safety and efficacy, rarely demonstrate superiority compared to standard AEDs, leaving placebo or pseudo-placebo as the only acceptable internal controls.

The pseudo-placebo withdrawal to monotherapy study model assigns treatment-resistant patients to receive a study drug or a suboptimal maintenance dose of a safe and effective active drug. Once patients are randomized and standardized to the intended dose, they undergo a withdrawal phase (when background AEDs are removed over a specified time frame) followed by a monotherapy phase. The trial continues until either all phases are completed or patients reach pre-specified endpoints.

Study leader Dr. Jacqueline French explains why this clinical trial model isn't suited for epilepsy patients. "Epilepsy is different from other conditions where placebo may be utilized (such as hypertension), since
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Contact: Dawn Peters
healthnews@wiley.com
781-388-8408
Wiley-Blackwell
Source:Eurekalert

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