如果单一疗法不能有效控制癫痫发作，则与抗癫痫药物 (ASM) 联合治疗是一种合理的策略，从而提高耐受性和治疗持续性。比较患者中不同 ASM 组合的疗效。接受单一疗法的癫痫患者添加了第二种 ASM台湾长庚研究数据库中 2009 年 1 月至 2019 年 5 月期间的两种药物联合治疗纳入分析。ASM 组合根据其主要作用机制 (MoA) 进行比较，如下： γ-氨基丁酸受体 (G)、钠通道阻滞剂 (SC)、突触小泡蛋白 2A (SV2)、钙通道阻滞剂 (C) 和多种机制 (M)。比较治疗持续性，并分析持续性的预测因素。本研究总共纳入了 3033 名患者。与具有相似 MoAs 的 ASM（特别是 SC 和 M 组合）相比，具有不同 MoAs 的组合 ASM 的治疗持续时间明显更长。接受具有不同 MoA 的组合 ASM 的患者停止治疗的可能性较小 [调整后的风险比：0.83（95% CI：0.75-0.93），p<0.001]。在所有组合中，SC  SV2组合的治疗持续时间最长（平均±SD：912.7±841.6天）。同时，接受G组合的患者比接受SC  SV2组合的患者有更高的停止治疗的风险。在所有 MoA 类别中，潜在的恶性肿瘤都与治疗中断的风险增加相关。接受 SC、SV2 和 M 组合治疗的男性患者比女性患者更有可能停止治疗。此外，患有肾脏疾病的患者更有可能停止使用 SV2 组合治疗。具有不同 MoAs 的 ASM 组合比具有相似 MoAs 的 ASM 组合（尤其是 SC 和 M 组合）具有更好的疗效和耐受性。在我们的队列中，与停止治疗相关的因素包括潜在的恶性肿瘤、男性和肾脏疾病。如果单一疗法无法充分控制癫痫发作，这些发现可能会为 ASM 组合的使用提供有价值的见解。© 作者，2023。

Combination therapy with antiseizure medications (ASMs) is a rational strategy if monotherapy cannot effectively control seizures, thereby aiming to improve tolerance and treatment persistence.To compare the efficacy of different ASM combinations among patients.Patients with epilepsy on monotherapy who had a second ASM added as concomitant two-drug therapy from January 2009 to May 2019 in the Chang Gung Research Database, Taiwan, were included in the analysis.ASM combinations were compared based on their primary mechanism of action (MoA) which are as follows: gamma-aminobutyric acid receptor (G), sodium channel blocker (SC), synaptic vesicle protein 2A (SV2), calcium channel blocker (C), and multiple mechanisms (M). Treatment persistence was compared, and the predictors of persistence were analyzed.In total, 3033 patients were enrolled in this study. Combined ASMs with different MoAs had significantly longer treatment persistence than ASMs with similar MoAs, specifically SC and M combinations. Patients receiving combined ASMs with different MoAs were less likely to discontinue treatment [adjusted hazards ratio: 0.83 (95% CI: 0.75-0.93), p < 0.001]. Among all combinations, the SC + SV2 combination had the longest treatment persistence (mean ± SD: 912.7 ± 841.6 days). Meanwhile, patients receiving the G combination had a higher risk of treatment discontinuation than those receiving the SC + SV2 combination. Underlying malignancies were associated with an increased risk of treatment discontinuation across all MoA categories. Male patients receiving the SC, SV2, and M combinations were more likely to discontinue treatment than female patients. Moreover, patients with renal disease were more likely to discontinue treatment with the SV2 combinations.ASM combinations with different MoAs had superior efficacy and tolerability to ASM combinations with similar MoAs, particularly SC and M combinations. In our cohort, factors associated with treatment discontinuation included underlying malignancy, male sex, and renal disease. These findings may provide valuable insights into the use of ASM combinations if monotherapy cannot adequately control seizures.© The Author(s), 2023.