Tolerability, efficacy and retention rate of Brivaracetam in patients previously treated with Levetiracetam: A monocenter retrospective outcome analysis

Hirsch, M.; Hintz, Mandy; Specht, Anja; Schulze‐Bonhage, Andreas

doi:10.1016/j.seizure.2018.07.017

Cited by 60 publications

(71 citation statements)

References 34 publications

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“…18 The higher incidence in this study is likely due to the large proportion of patients with psychiatric comorbidity (44.2%)-such patients are typically excluded from RCTs. 9,14 More patients who switched overnight experienced seizure worsening than those who transitioned progressively (8.1% vs 6.9%). Titration, therefore, could be avoided for patients at high risk of breakthrough seizures and accidents, or those experiencing severe AEs requiring rapid AED replacement.…”

Section: Months 6 Months 12 Monthsmentioning

confidence: 99%

“…28,29 For patients who transitioned from LEV to BRV, a 1:10 ratio was used for those on a median LEV dosage ≤2000 mg/day; for those on >2000 mg/day, equivalence was not clear and a higher ratio (1:15) was used, as observed in other studies. 9,14 More patients who switched overnight experienced seizure worsening than those who transitioned progressively (8.1% vs 6.9%). In contrast, those who transitioned progressively reported more AEs that led to discontinuation (5.6% vs 1.2%).…”

Section: Months 6 Months 12 Monthsmentioning

confidence: 99%

“…Several real-life BRV studies have been reported; however, most had small sample sizes and short follow-ups. [9][10][11][12][13][14] The main objective of the study reported here was to evaluate the effectiveness and tolerability of BRV over a 1-year period in a large population of patients with focal epilepsies. Further objectives were to compare responses in particular patient subgroups, including those previously treated with LEV.…”

Section: Introductionmentioning

confidence: 99%

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BRIVA-LIFE-A multicenter retrospective study of the long-term use of brivaracetam in clinical practice

et al. 2018

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Objectives: Evaluate long-term effectiveness and tolerability of brivaracetam in clinical practice in patients with focal epilepsy. Materials and Methods:This was a multicenter retrospective study. Patients aged ≥16 years were started on brivaracetam from November 2016 to June 2017 and followed over 1 year. Data were obtained from medical records at 3, 6 and 12 months after treatment initiation for evaluation of safety-and seizure-related outcomes.Results: A total of 575 patients were included in analyses; most had been treated with ≥4 lifetime antiepileptic drugs. Target dosage was achieved by 30.6% of patients on the first day. Analysis of primary variables at 12 months revealed that mean reduction in seizure frequency was 36.0%, 39.7% of patients were ≥50% responders and 17.5% were seizure-free. Seizure-freedom was achieved by 37.5% of patients aged ≥65 years. Incidence of adverse events (AEs) and psychiatric AEs (PAEs) was 39.8% and 14.3%, respectively, and discontinuation due to these was 8.9% and 3.7%, respectively. Somnolence, irritability, and dizziness were the most frequently reported AEs. At baseline, 228 (39.7%) patients were being treated with levetiracetam; most switched to brivaracetam (dose ratio 1:10-15). Among those who switched because of PAEs (n = 53), 9 (17%) reported PAEs on brivaracetam, and 3 (5.7%) discontinued because of PAEs. Tolerability was not highly affected among patients with learning disability or psychiatric comorbidity. Conclusions:In a large population of patients with predominantly drug-resistant epilepsy, brivaracetam was effective and well-tolerated; no unexpected AEs occurred over 1 year, and the incidence of PAEs was lower compared with levetiracetam.

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Section: Months 6 Months 12 Monthsmentioning

confidence: 99%

Section: Months 6 Months 12 Monthsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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BRIVA-LIFE-A multicenter retrospective study of the long-term use of brivaracetam in clinical practice

et al. 2018

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“…Irrespective of whether an AED had been totally withdrawn or not, the Kaplan‐Meier‐estimated 6‐month retention with censoring of patients without documented discontinuation of brivaracetam was 70.7%. Retrospective studies of brivaracetam have reported 6‐month retention rates of 51.5‐80.2% 6–9 . A Kaplan‐Meier‐estimated 6‐month retention rate of 91.0% was reported in a pooled analysis of data from 2051 patients with uncontrolled focal seizures treated with adjunctive brivaracetam (modal doses of 50‐200 mg/d) in randomized controlled trials and long‐term follow‐up studies 10 …”

Section: Discussionmentioning

confidence: 99%

Brivaracetam substituting other antiepileptic treatments: Results of a retrospective study in German epilepsy centers

et al. 2020

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Objective To evaluate the success of initiation of adjunctive brivaracetam in patients who required a change in antiepileptic drug (AED) regimen and substituted at least one AED with brivaracetam. Methods In this retrospective noninterventional study conducted in specialized epilepsy centers across Germany, patients initiated adjunctive brivaracetam between February 15, 2016, and August 31, 2016, as part of an intended change in AED regimen. The primary effectiveness variable was the proportion of patients who continued on brivaracetam after 3 months, and withdrew at least one AED either before or within 6 months after brivaracetam initiation. Results Five hundred and six patients had at least one brivaracetam dose and were included in the safety set (SS). Four hundred and seventy patients started to reduce the dose of one AED before/after brivaracetam initiation, had at least one concomitant AED at brivaracetam initiation, and were included in the full analysis set (FAS) for effectiveness analyses. At baseline, patients had a median of seven lifetime AEDs and a median of 3.8 seizures/28 days. In the SS, 85.2% of patients withdrew one AED before/after initiation of brivaracetam, most commonly levetiracetam (49.4%). 46.2% of patients substituted another AED with brivaracetam within 24 hours (fast withdrawal). The proportions of patients (FAS) who continued on brivaracetam after 3 and 6 months and withdrew one AED were 75.5% and 46.6%, respectively. After 6 months, 32.1% of patients were 50% responders; 13.0% were seizure‐free. In the SS, 34.6% of patients reported treatment‐emergent adverse events (TEAEs); 21.9% had TEAEs that were assessed by the treating physician as drug‐related. Incidences of behavioral AEs before (3‐month baseline) and after brivaracetam initiation in patients who withdrew levetiracetam were 19.2% and 8.0%, respectively (5.0% and 7.7% in patients who withdrew other AEDs). Significance Brivaracetam was effective and well‐tolerated in patients who required a change in AED drug regimen and initiated adjunctive brivaracetam in German clinical practice.

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“…M. Hirsch и соавт. (2018) ретроспективно изучали эффективность и переносимость бриварацетама у пациентов, ранее получавших леветирацетам [9]. В исследование было включено 102 пациента, находящихся под наблюдением не менее 6 мес, средняя продолжительность лечения бриварацетамом составила 301,6 (± 156,8) сут.…”

Section: Ch I Ld Neurology R U S S I a N J O U R N A L O Funclassified

Efficacy and tolerability of brivaracetam in the treatment of epilepsy: literature review and own experience

Пылаева¹,

Мухин²

2018

Rus. ž. det. nevrol.

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Background. Despite significant advances in epileptology, approximately 30 % of patients suffer from drug-resistant epilepsy. Numerous approaches are currently available to treat epilepsy; however, there are still many patients with treatment-resistant disease, in whom surgery is impossible and alternative methods (vagus nerve stimulation and ketogenic diet) are ineffective. Thus, searching for new effective antiepileptic drugs (AED) for these patients remains highly relevant. In this article, we reviewed available publications and provided own results on the efficacy and tolerability of brivaracetam (Briviact®) in patients with intractable focal epilepsy.Materials and methods. The study included 8 patients aged between 16 and 35 years (mean age 18.3 years; 2 males and 6 females) with intractable focal epilepsy treated at the Svt. Luka’s Institute of Child Neurology and Epilepsy between February 1st, 2017 and September 1st, 2018.All patients received brivaracetam as an additional AED for the treatment of focal and bilateral convulsive seizures. Patients were followed up for 1 to 7.5 months. Brivaracetam was added to 1 or 2 AED (valproate, topiramate, or carbamazepine/oxcarbazepine) at a dose of 100–200 mg/day divided into 2 doses.Results and discussion. Good therapeutic effect (more than 50 % reduction in seizure frequency) was registered in 4 patients (50 %). Two patients (25 %) achieved a 25–50 % reduction in seizure frequency. Minimal clinical efficacy with no effect was observed in one patient (12.5 %). One patient (12.5 %) had aggravation of focal and motor seizures. Brivaracetam significantly reduced the severity (intensity and duration) of epileptic seizures in 70 % of patients. Four patients demonstrated substantial improvements on electroencephalogram (decreased epileptiform activity). One patient had complete suppression of epileptiform activity. Brivaracetam was most effective for bilateral convulsive seizures: 4 out of 5 patients experienced complete relief of these seizures.Brivaracetam demonstrated good tolerability: no side effects were registered in this study. Six out of 8 participants (75 %) currently continue treatment with brivaracetam. It is important that none of the patients had to stop brivaracetam due to poor tolerability. Of note, all of study participants started to receive brivaracetam because they had seizures resistant to multiple (more than 2–3) AED.Conclusion. Our findings suggest high efficacy and good tolerability of brivaracetam in patients with focal epilepsy. Our results are also consistent with the data reported by foreign authors.

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Tolerability, efficacy and retention rate of Brivaracetam in patients previously treated with Levetiracetam: A monocenter retrospective outcome analysis

Abstract: Overall, intolerability or ineffectiveness of prior treatment with LEV seems not to preclude a good response to BRV. BRV was substantially better tolerated than LEV.

Cited by 60 publications

References 34 publications

BRIVA-LIFE-A multicenter retrospective study of the long-term use of brivaracetam in clinical practice

BRIVA-LIFE-A multicenter retrospective study of the long-term use of brivaracetam in clinical practice

Brivaracetam substituting other antiepileptic treatments: Results of a retrospective study in German epilepsy centers

Efficacy and tolerability of brivaracetam in the treatment of epilepsy: literature review and own experience

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