Retention of brivaracetam in adults with drug-resistant epilepsy at a single tertiary care center

Green, Sebastian F.; Hare, Nisha; Kassam, Mehreen; Rugg‐Gunn, Fergus; Koepp, Matthias J.; Sander, Josemir W.; Rajakulendran, Sanjeev

doi:10.1016/j.yebeh.2022.108868

Cited by 5 publications

(6 citation statements)

References 38 publications

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“…We cannot exclude that the majority discontinued CNB so that the retention rate might have been lower than that reported. However, if we had considered all PWE lost to follow‐up as discontinuers, as was sometimes done in other studies, 48 the retention rate would still have been 71.5%, which is well within the range of other ASMs and the retrospective real‐world studies about CNB therapy 16,17,19,20,23,24,26,30–32,48–53 …”

Section: Limitationsmentioning

confidence: 53%

The cenobamate KORK study—A prospective monocenter observational study investigating cenobamate as an adjunctive therapy in refractory epilepsy, with comparisons to historical cohorts treated with add‐on lacosamide, perampanel, and brivaracetam

Steinhoff,

Georgiou,

Intravooth

2024

Epilepsia Open

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ObjectiveIn Europe, cenobamate has been approved for use as an adjunctive therapy in adult patients with epilepsy (PWE) with focal‐onset seizures (FOS) who have not responded satisfactorily to treatment with at least two antiseizure medications (ASMs). Pivotal trials and real‐world observational studies have demonstrated a high efficacy of cenobamate, even in very difficult‐to‐treat epilepsies. Our aim was to investigate the efficacy of add‐on cenobamate in adult PWE who were prospectively monitored. We compared these results with those previously obtained for add‐on lacosamide, perampanel, and brivaracetam therapy.MethodsPatients were enrolled from the CENKORK study, which is a prospective, non‐interventional, open‐label, monocenter cohort study of adult PWE experiencing FOS. The titration of cenobamate was performed according to the guidelines outlined in the summary of product characteristics. The primary outcome measure was the retention rate at 6 months and 1 year. In addition, we assessed seizure‐free rates, the proportion of patients achieving at least a 50% seizure reduction, adverse events, and the reasons for treatment discontinuation. These outcome measures were compared with historical controls treated with adjunctive lacosamide, perampanel, or brivaracetam at our center.ResultsBetween June 2021 and 2022, 172 PWE with ongoing FOS were included. 22 cases were lost to follow‐up, leaving 150 cases for the 1‐year assessment. The retention rates at 6 months and 1 year were 88.7% and 80%, respectively. Seizure freedom was achieved in 14% of patients at both the 6‐month and 1‐year marks, while the ≥50% responder rates were 50% and 61%, respectively. The 6‐month retention rate was significantly higher in cenobamate than in other ASMs (p < 0.001 for each comparator). Adverse events were significantly more common with perampanel (p < 0.001).SignificanceAdd‐on cenobamate proved to be particularly efficacious compared to our experience with other recently introduced ASMs.Plain Language SummaryThis observational study was carried out in 172 adult patients with difficult‐to‐treat epilepsy who were treated with adjunctive cenobamate. After 1 year, the data of 150 patients could be analyzed. Seizure freedom, in the preceding 3 months, was achieved in 14%. The rate of PWE continuing cenobamate was 80%. In our hands, cenobamate showed promising efficacy and tolerability even when compared to other recently introduced antiseizure medications.

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Section: Limitationsmentioning

confidence: 53%

The cenobamate KORK study—A prospective monocenter observational study investigating cenobamate as an adjunctive therapy in refractory epilepsy, with comparisons to historical cohorts treated with add‐on lacosamide, perampanel, and brivaracetam

Steinhoff,

Georgiou,

Intravooth

2024

Epilepsia Open

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“…The BPHS also covers the AEDs that are more di cult to access (LMT, CLB, and TPM) [31] but patients report frequent drug shortages. The lack of regularity in access can directly compromise the family income, cause underuse of the medication, or even lead to the total interruption of treatment [32]. Our numbers show that more than half of patients have access irregularities, evidencing an important limitation of medication policies in Brazil.…”

Section: Discussionmentioning

confidence: 84%

“…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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“…Brivaracetam is a recently approved ASM that is being used as an adjunctive therapy for patients with focal seizures [230][231][232][233][234]. Brivaracetam has a similar mechanism of action as levetiracetam in that it exhibits high-affinity binding to SV2A vesicles.…”

Section: Brivaracetammentioning

confidence: 99%

“…Ten of these patients had complete resolution of focal seizures [235]. A study of 200 adults with medically refractory epilepsy who were treated with brivaracetam found that 23% experienced at least a 50% reduction in seizure frequency [231]. Other research indicated that 50 mg/day of brivaracetam is an effective dose to significantly reduce seizure frequency [237].…”

Section: Brivaracetammentioning

confidence: 99%

Therapeutic Strategies to Ameliorate Neuronal Damage in Epilepsy by Regulating Oxidative Stress, Mitochondrial Dysfunction, and Neuroinflammation

Madireddy

2023

Brain Sciences

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Epilepsy is a central nervous system disorder involving spontaneous and recurring seizures that affects 50 million individuals globally. Because approximately one-third of patients with epilepsy do not respond to drug therapy, the development of new therapeutic strategies against epilepsy could be beneficial. Oxidative stress and mitochondrial dysfunction are frequently observed in epilepsy. Additionally, neuroinflammation is increasingly understood to contribute to the pathogenesis of epilepsy. Mitochondrial dysfunction is also recognized for its contributions to neuronal excitability and apoptosis, which can lead to neuronal loss in epilepsy. This review focuses on the roles of oxidative damage, mitochondrial dysfunction, NAPDH oxidase, the blood–brain barrier, excitotoxicity, and neuroinflammation in the development of epilepsy. We also review the therapies used to treat epilepsy and prevent seizures, including anti-seizure medications, anti-epileptic drugs, anti-inflammatory therapies, and antioxidant therapies. In addition, we review the use of neuromodulation and surgery in the treatment of epilepsy. Finally, we present the role of dietary and nutritional strategies in the management of epilepsy, including the ketogenic diet and the intake of vitamins, polyphenols, and flavonoids. By reviewing available interventions and research on the pathophysiology of epilepsy, this review points to areas of further development for therapies that can manage epilepsy.

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Retention of brivaracetam in adults with drug-resistant epilepsy at a single tertiary care center

Cited by 5 publications

References 38 publications

The cenobamate KORK study—A prospective monocenter observational study investigating cenobamate as an adjunctive therapy in refractory epilepsy, with comparisons to historical cohorts treated with add‐on lacosamide, perampanel, and brivaracetam

The cenobamate KORK study—A prospective monocenter observational study investigating cenobamate as an adjunctive therapy in refractory epilepsy, with comparisons to historical cohorts treated with add‐on lacosamide, perampanel, and brivaracetam

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

Therapeutic Strategies to Ameliorate Neuronal Damage in Epilepsy by Regulating Oxidative Stress, Mitochondrial Dysfunction, and Neuroinflammation

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