Effect and tolerability of perampanel in patients with drug-resistant epilepsy

Lossius, Ida Marie Bakke; Svendsen, Torleiv; Sødal, Hild Flatmark; Kjeldstadli, Kari; Lossius, Morten I.; Nakken, Karl Otto; Landmark, Cecilie Johannessen

doi:10.1016/j.yebeh.2021.107965

Cited by 14 publications

(12 citation statements)

References 37 publications

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“…Our observational investigation revealed a noteworthy discovery, wherein 72.3% of patients ( n = 86) exhibited a positive response over the entire duration of observation, surpassing the typical range of efficacy reported in randomized controlled trials on perampanel, which typically register efficacy rates between 26 and 56% ( 24 ). A clinical practice conducted in Germany, based on 6 months of observation, indicated that 46% of patients responded to treatment, evincing a reduction of at least 50% in seizure frequency ( 25 ).…”

Section: Discussionmentioning

confidence: 67%

A nomogram to predict the treatment benefit of perampanel in drug-resistant epilepsy patients

Zhu,

Li,

Wei

et al. 2023

Front. Neurol.

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ObjectiveThe objective of this study was to identify the factors that affect the efficacy of added perampanel for the treatment of drug-resistant epilepsy (DRE), and to develop a reliable nomogram to predict the benefit of this addition.MethodsA retrospective clinical analysis was conducted on DRE patients who received perampanel treatment and who were followed up for at least 6 months from January 2020 and September 2023 at the Epilepsy Center of Fujian Medical University Union Hospital. Data from January 2020 to December 2021 were used as development dataset to build model, while the data from January 2022 to September 2023 were used as validation dataset for internal validation. The predictive factors that affected the efficacy of perampanel as DRE treatment were included in the final multivariate logistic regression model, and a derived nomogram was established.ResultsA total of 119 DRE patients who received perampanel treatment were included in this study (development datasets: n = 76; validation data: n = 43). Among them, 72.3% (n = 86) showed a 50% or greater reduction in seizure frequency after perampanel treatment. Of all the parameters of interest, sex, age, history of generalized tonic-clonic seizures, and the number of antiseizure medications were identified as significant predictors for estimating the benefit of adding perampanel for the treatment of DRE. A model incorporating these four variables was developed, and a nomogram was constructed to calculate the probability of benefit of adding perampanel using the model coefficients. The C-index of the predictive model was 0.838, and the validation C-index was 0.756. The goodness-of-fit test showed good calibration of the model (p = 0.920, 0.752 respectively).ConclusionThe proposed nomogram has significant clinical potential for predicting the probability of benefit of perampanel as DRE treatment. This nomogram can be used to identify DRE patients who could benefit from the early addition of perampanel to their treatment regimen.

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Section: Discussionmentioning

confidence: 67%

A nomogram to predict the treatment benefit of perampanel in drug-resistant epilepsy patients

Zhu,

Li,

Wei

et al. 2023

Front. Neurol.

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“…In a recent study, the possible relationship between serum concentrations, pharmacokinetic variability, and evaluation of efficacy and tolerability was studied in patients with refractory epilepsy. However, it was difficult to draw conclusions on the correlations between serum levels and efficacy and tolerability due to low sample size and the large variability between patients [ 25 ]. Further studies are also required to evaluate the relationship between salivary PER concentrations, antiseizure efficacy, and adverse effects.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Salivary Monitoring of Perampanel in Patients with Epilepsy Using a Volumetric Absorptive Microsampling Technique

Palmisani

Tartara²,

Landmark

et al. 2023

Pharmaceutics

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The objective of this study was to validate a novel assay using the volumetric absorptive microsampling (VAMS) technique combined with liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) for the determination of the antiseizure medication perampanel in saliva and its clinical applicability in patients with epilepsy. VAMS tips were loaded with 30 μL of saliva and dried for 60 min. Analytes were extracted with methanol. The supernatant was evaporated under a gentle stream of nitrogen and reconstituted with 60 μL of methanol. Separation and quantification were achieved on a monolithic column connected to a mass spectrometer. Calibration curves were linear between 0.5 and 300 ng/mL. Intra- and inter-day accuracy was within 85.6–103.2% and intra-day and inter-day precision did not exceed 12.1%. Perampanel was stable in samples collected by VAMS and stored under different storage conditions. The VAMS-LC-MS/MS method was validated according to internationally accepted criteria and tested in patients with epilepsy who were receiving a combination of perampanel and other antiseizure medications. The method showed adequate bioanalytical performances, holding great potential as an alternative strategy to support domiciliary TDM in patients with epilepsy treated with perampanel according to the simplicity of sample collection.

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“…It is also noteworthy that there are new AED available on the market, such as perampanel and brivaracetam; these are not offered by the BPHS [30], however they are recommended for the treatment of pharmacoresistant epilepsy in developed countries [32][33]. Thus, restrictions on the use of the antiepileptic drug arsenal may favour therapeutic associations and possibly increase AE [34].…”

Section: Discussionmentioning

confidence: 99%

Pharmacoresistant epilepsy in adult patients: a cross-sectional study on pharmacotherapeutic characteristics, access, knowledge, and treatment adherence

Mencucini¹,

Campos

Lopes

et al. 2023

Preprint

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Purpose: The purpose of this study is to describe the pharmacotherapeutic, demographic, and socioeconomic characteristics of patients with pharmacoresistant epilepsy treated at a specialized outpatient clinic, as well as to assess the knowledge and adherence of patients to pharmacological treatment and to identify the most frequent adverse events (AE). Methods: Cross-sectional study, based on an interview using validated questionnaires and document analysis of medical records. Results:There was a high prevalence of polytherapy 92.1 % (200/217), and an average treatment time of 25.8 years. The most used antiepileptic drugs were clobazam, lamotrigine, carbamazepine and topiramate. The average AE score was 41.4 points (SD = 11.4). Regarding access to the drugs used, 66.4 % (144/217) of the patients reported having free access. The patients' knowledge about antiepileptic drug therapy obtained a mean score of 93.5 points (SD = 16.7 points), and these patients with more excellent knowledge also had greater adherence to treatment [OR= 2.51 (95 % CI, 1.11; 5.65)] and a lower incidence of AE [OR= 0.47 (95 % CI, 0.27; 0.83)]. Non-adherence rates were found to be 47.5 % (103/217), and variables that were significantly associated (p˂0.05) with non-adherence were found. Conclusion: Patients have good knowledge about pharmacological treatment, and prescriptions are in line with national guidelines, but they need integrated and continuous care work to optimize adherence and health services.

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Effect and tolerability of perampanel in patients with drug-resistant epilepsy

Cited by 14 publications

References 37 publications

A nomogram to predict the treatment benefit of perampanel in drug-resistant epilepsy patients

A nomogram to predict the treatment benefit of perampanel in drug-resistant epilepsy patients

Therapeutic Salivary Monitoring of Perampanel in Patients with Epilepsy Using a Volumetric Absorptive Microsampling Technique

Pharmacoresistant epilepsy in adult patients: a cross-sectional study on pharmacotherapeutic characteristics, access, knowledge, and treatment adherence

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