Add on Brivaracetam improves long-term seizure control in patients with various epilepsy syndromes

Around 50 million people worldwide have epilepsy, making it one of the most common neurological diseases globally. It is estimated that 70% of people living with epilepsy could live seizure- free if properly diagnosed and treated.

A retrospective study by Adam Strzelczyk and team revealed that add-on brivaracetam was well tolerated in a real-world setting and improved long-term seizure control in patients with various epilepsy syndromes. Further  brivaracetam (BRV) showed a clinically useful 50 % responder rate of 33% at 12 months and overall retention of >50%. Also brivaracetam was well tolerated; however, psychobehavioral adverse events was also noticed in the study.

The findings of the study are published in Epilepsia.

The objective of the study was to evaluate the long-term efficacy, retention, and tolerability of add-on brivaracetam (BRV) in clinical practice.

The study was a multicenter, retrospective cohort study recruited all patients who initiated BRV between February and November 2016, with observation until February 2021.

The results of the study are

• A total of 262 patients (40 years, 129 men) were analyzed, including 227 (87%) diagnosed with focal epilepsy, 19 (7%) with genetic generalized epilepsy, and 16 (6%) with other or unclassified epilepsy syndromes.

• Only 26 (10%) patients had never received levetiracetam (LEV), whereas 133 (50.8%) were switched from LEV.

• The length of BRV exposure ranged from 1 day to 5 years, with a median retention time of 1.6 years, resulting in a total BRV exposure time of 6829 months (569 years).

• The retention rate was 61.1% at 12 months, with a reported efficacy of 33.1% (79/239; 50%), including 10.9% reported as seizure-free.

• The retention rate for the entire study period was 50.8%, and at last follow-up, 133 patients were receiving BRV at a mean dose of 222 ± 104 mg, including 52 (39.1%) who exceeded the recommended upper dose of 200 mg.

• Fewer concomitant antiseizure medications and switching from LEV to BRV correlated with better short-term responses, but no positive long-term outcomes.

• BRV was discontinued in 63 (24%) patients due to insufficient efficacy, in 29 (11%) for psychobehavioral adverse events, in 25 (10%) for other adverse events, and in 24 (9%) for other reasons.

The researchers concluded that "BRV showed a clinically useful 50% responder rate of 33% at 12 months and overall retention of >50%, despite 90% of included patients having previous LEV exposure. BRV was well tolerated; however, psychobehavioral adverse events occurred in one out of 10 patients. Although we identified short term response, we could not identify significant predictors for long-term outcomes."

Reference:

https://doi.org/10.1111/epi.17087