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Brivaracetam efficacy and tolerability in clinical practice: A UK-based retrospective multicenter service evaluation

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  • J. Adewusi
  • C. Burness
  • S. Ellawela
  • H. Emsley
  • R. Hughes
  • C. Lawthom
  • M. Maguire
  • B. McLean
  • R. Mohanraj
  • M. Oto
  • S. Singhal
  • M. Reuber
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Article number106967
<mark>Journal publication date</mark>1/05/2020
<mark>Journal</mark>Epilepsy and Behavior
Volume106
Number of pages8
Publication StatusPublished
Early online date14/03/20
<mark>Original language</mark>English

Abstract

Purpose: This multicenter service evaluation explores the efficacy and tolerability of brivaracetam (BRV) in an unselected, consecutive population in ‘real-life’ clinical settings. Method: We retrospectively collected data from patient records at 11 UK hospitals and epilepsy centers. Consecutive patients prescribed BRV with at least 3 months of follow-up (FU) were included. Apart from reporting effectiveness and tolerability of BRV across the whole cohort, we compared treatment outcomes depending on previous levetiracetam use (LEV + versus LEV −), comorbid learning disability (LD + versus LD −), and epilepsy syndrome (focal versus generalized epilepsy). Results: Two hundred and ninety patients (46% male, median age: 38 years, range: 15 to 77) with ≥ 3 months of FU were included. The median duration of BRV exposure was 12 months (range: 1 day to 72 months). Overall BRV retention was 71.1%. While 56.1% of patients improved in terms of seizure frequency category (daily, weekly, monthly, yearly seizures), 23.1% did not improve on this measure and 20.8% deteriorated. In terms of seizure frequency, 21% of patients experienced a ≥ 50% reduction, with 7.0% of all patients becoming seizure-free. Treatment-emergent adverse events (AEs) were reported by 107 (36.9%) patients, but there were no serious AEs. The commonest AEs were sedation/fatigue (18.3%), mood changes (9.0%), and irritability/aggression (4.8%). There were no significant differences in drug retention, seizure frequency outcomes, or AEs between the LEV + and LEV − subgroups, or between patients with generalized or focal epilepsies. Although 15.5% of patients in the LD + group achieved a ≥ 50% reduction, this rate was lower than in the LD − group. Conclusions: This ‘real-life’ evaluation suggests that reductions in seizure frequency can be achieved with BRV in patients with highly refractory epilepsy. Brivaracetam may be a useful treatment option in patients who have previously failed to respond to or tolerate LEV, those with LD, or (off-label) those with generalized epilepsies.