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© 2020Purpose: 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.
Author(s): Adewusi J, Burness C, Ellawela S, Emsley H, Hughes R, Lawthom C, Maguire M, McLean B, Mohanraj R, Oto M, Singhal S, Reuber M
Publication type: Article
Publication status: Published
Journal: Epilepsy and Behavior
Year: 2020
Volume: 106
Print publication date: 01/05/2020
Online publication date: 14/03/2020
Acceptance date: 01/02/2020
ISSN (print): 1525-5050
ISSN (electronic): 1525-5069
Publisher: Academic Press Inc.
URL: https://doi.org/10.1016/j.yebeh.2020.106967
DOI: 10.1016/j.yebeh.2020.106967
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