Long-term safety and efficacy of add-on cannabidiol in patients with Lennox-Gastaut syndrome: Results of a long-term open-label extension trial

Anup D Patel; Maria Mazurkiewicz-Bełdzińska; Richard F Chin; Antonio Gil-Nagel; Boudewijn Gunning; Jonathan J Halford; Wendy Mitchell; Michael Scott Perry; Elizabeth A Thiele; Arie Weinstock; Eduardo Dunayevich; Daniel Checketts; Orrin Devinsky

doi:10.1111/epi.17000

Long-term safety and efficacy of add-on cannabidiol in patients with Lennox-Gastaut syndrome: Results of a long-term open-label extension trial

Epilepsia. 2021 Sep;62(9):2228-2239. doi: 10.1111/epi.17000. Epub 2021 Jul 20.

Affiliations

¹ Nationwide Children's Hospital, Columbus, Ohio, USA.
² Department of Developmental Neurology, Medical University of Gdańsk, Gdańsk, Poland.
³ Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, UK.
⁴ Neurology Department, Ruber Internacional Hospital, Madrid, Spain.
⁵ Stichting Epilepsie Instellingen Nederland, Zwolle, the Netherlands.
⁶ Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA.
⁷ Keck School of Medicine, University of Southern California and Children's Hospital Los Angeles, Los Angeles, California, USA.
⁸ Cook Children's Medical Center, Fort Worth, Texas, USA.
⁹ Massachusetts General Hospital, Boston, Massachusetts, USA.
¹⁰ Oishei Children's Hospital, Buffalo, New York, USA.
¹¹ Greenwich Biosciences, Carlsbad, California, USA.
¹² GW Research Ltd., Cambridge, UK.
¹³ New York University Comprehensive Epilepsy Center, New York, USA.

PMID: 34287833
DOI: 10.1111/epi.17000

Abstract

Objective: Lennox-Gastaut syndrome (LGS) is an epileptic encephalopathy that is often treatment resistant. Efficacy and safety of add-on cannabidiol (CBD) to treat seizures associated with LGS was demonstrated in two randomized controlled trials (RCTs). Patients who completed the RCTs were invited to enroll in this long-term open-label extension (OLE) trial, GWPCARE5 (NCT02224573). We present the final analysis of safety and efficacy outcomes from GWPCARE5.

Methods: Patients received plant-derived highly purified CBD (Epidiolex in the United States; Epidyolex in the European Union; 100 mg/ml oral solution), titrated to a target maintenance dose of 20 mg/kg/day over 2 weeks. Based on response and tolerability, CBD could then be reduced or increased up to 30 mg/kg/day.

Results: Of 368 patients with LGS who completed the RCTs, 366 (99.5%) enrolled in this OLE. Median and mean treatment duration were 1090 and 826 days (range = 3-1421), respectively, with a mean modal dose of 24 mg/kg/day. Adverse events (AEs) occurred in 96% of patients, serious AEs in 42%, and AE-related discontinuations in 12%. Common AEs were convulsion (39%), diarrhea (38%), pyrexia (34%), and somnolence (29%). Fifty-five (15%) patients experienced liver transaminase elevations more than three times the upper limit of normal; 40 (73%) were taking concomitant valproic acid. Median percent reductions from baseline ranged 48%-71% for drop seizures and 48%-68% for total seizures through 156 weeks. Across all 12-week visit windows, 87% or more of patients/caregivers reported improvement in the patient's overall condition on the Subject/Caregiver Global Impression of Change scale.

Significance: Long-term add-on CBD treatment had a similar safety profile as in the original RCTs. Sustained reductions in drop and total seizure frequency were observed for up to 156 weeks, demonstrating long-term benefits of CBD treatment for patients with LGS.

Keywords: cannabinoid; childhood onset epilepsy; drop seizures; epileptic encephalopathy; treatment resistant.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Anticonvulsants / adverse effects
Cannabidiol / therapeutic use*
Epilepsies, Myoclonic* / drug therapy
Humans
Lennox Gastaut Syndrome* / drug therapy
Seizures / drug therapy

Substances

Anticonvulsants
Cannabidiol

Associated data

ClinicalTrials.gov/NCT02224573