Brivaracetam in the Treatment of Patients with Epilepsy-First Clinical Experiences

Abstract

Objectives: To assess first clinical experiences with brivaracetam (BRV) in the treatment of epilepsies.

Methods: Data on patients treated with BRV from February to December 2016 and with at least one clinical follow-up were collected from electronic patient records. Data on safety and efficacy were evaluated retrospectively.

Results: In total, 93 patients were analyzed; 12 (12.9%) received BRV in monotherapy. The mean duration to follow-up was 4.85 months (MD = 4 months; SD = 3.63). Fifty-seven patients had more than one seizure per month at baseline and had a follow-up of more than 4 weeks; the rate of ≥50% responders was 35.1% (n = 20) in this group, of which five (8.8%) patients were newly seizure-free. In 50.5% (47/93), patients were switched from levetiracetam (LEV) to BRV, of which 43 (46.2%) were switched immediately. Adverse events (AE) occurred in 39.8%, with 22.6% experiencing behavioral and 25.8% experiencing non-behavioral AE. LEV-related AE (LEV-AE) were significantly reduced by switching to BRV. The discontinuation of BRV was reported in 26/93 patients (28%); 10 of those were switched back to LEV with an observed reduction of AE in 70%. For clinical reasons, 12 patients received BRV in monotherapy, 75% were seizure-free, and previous LEV-AE improved in 6/9 patients. BRV-related AE occurred in 5/12 cases, and five patients discontinued BRV.

Conclusion: BRV seems to be a safe, easy, and effective option in the treatment of patients with epilepsy, especially in the treatment of patients who have psychiatric comorbidities and might not be good candidates for LEV treatment. BRV broadens the therapeutic spectrum and facilitates personalized treatment.

Keywords: brivaracetam; epilepsy; levetiracetam; side effects; treatment.

Figure 1

Change in seizure frequency after initiation of BRV treatment.

Figure 2

Number of adverse events: [total number and number of behavioral and non-behavioral adverse events (AE)] under Levetiracetam (LEV) treatment and under brivaracetam (BRV) treatment in the subpopulation of patients who ever (actual or in prior treatment) had AE under LEV medication. Thirty-two patients had been switched immediately from LEV to BRV. **p < 0.001, and error bars indicate the mean error.