Brivaracetam promising in epilepsy patients with cognitive or psychiatric comorbidities: Data from EXPERIENCE analysis

In the large descriptive real-world analysis, brivaracetam was well tolerated and effective in adults with epilepsy and cognitive or learning disability (CLD) or psychiatric comorbidities (PC), as shown by low incidences of cognitive, psychiatric, and behavioral treatment-emergent adverse events (TEAEs). The findings were presented at the 2024 American Academy of Neurology (AAN) meeting and published in the prestigious medical journal Neurology.

EXPERIENCE/EPD332 was a pooled analysis of retrospective cohorts of epilepsy patients initiating brivaracetam in clinical practice. Wendyl D’Souza, The University of Melbourne in Melbourne, Australia, and colleagues aimed to assess the tolerability and effectiveness of brivaracetam in epilepsy patients with CLD or PC at baseline.

For this purpose, the researchers conducted a subgroup analysis of patients with CLD or PC.

Outcomes included ≥50% seizure reduction from baseline and continuous seizure freedom (CSF; no seizures after baseline) and TEAEs since the prior visit at 12 months. Patients with missing data following brivaracetam discontinuation were considered not seizure-free.

The following were the key findings of the study:

• Analyses by CLD status included 1635 patients (403/1232 with/without CLD).
• Patients with vs without CLD were younger (96.3/89.3% <65 years), had higher median seizure frequency (7.7/4.0 seizures/28 days [n=342/1035]), and a higher median number of prior antiseizure medications (7.0/4.0 [n=396/1215]) at index (date of brivaracetam initiation).
• In both subgroups, the median brivaracetam dose at index was 100 mg/day (with/without CLD: n=395/1211). At 12 months, ≥50% seizure reduction was 35.6/37.4% (n=264/553) and CSF was 5.7/14.2% (n=318/788).
• Patients with/without CLD (n=283/942) had similar incidences of TEAEs (11.3/8.7%), psychiatric (3.5/2.2%), cognitive (1.1/0.8%) and behavioral TEAEs (1.8/0.3%). Brivaracetam discontinuations during study follow-up were 37.1/32.6% (n=402/1228).
• Analyses by PC status included 1616 patients (605/1011 with/without PC).
• Baseline characteristics were generally similar between subgroups.
• In both subgroups, the median brivaracetam dose at index was 100 mg/day (with/without PC: n=597/996).
• At 12 months, patients with/without PC had similar 50% seizure reduction (38.7/36.1% [n=310/493]) and CSF (13.7/10.4% [n=424/661]).
• Patients with/without PC (n=410/803) had similar incidences of TEAEs (10.0/8.8%), psychiatric (2.7/2.5%), cognitive (1.2/0.9%), and behavioral TEAEs (0.7/0.5%).
• Brivaracetam discontinuations during study follow-up were 30.7/35.4% (n=603/1008).

In conclusion, the 12-month effectiveness and tolerability data from the International EXPERIENCE Pooled Analysis highlight the potential of brivaracetam as a promising treatment option for patients with epilepsy and cognitive or psychiatric comorbidities. These findings pave the way for personalized treatment approaches that address the unique needs of this patient population, ultimately improving outcomes and quality of life.

Reference:

https://doi.org/10.1212/WNL.0000000000204898