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. 2022 Dec;11(4):1789-1804.
doi: 10.1007/s40120-022-00402-3. Epub 2022 Sep 16.

Brivaracetam as Early Add-On Treatment in Patients with Focal Seizures: A Retrospective, Multicenter, Real-World Study

Simona Lattanzi  1 , Laura Canafoglia  2 , Maria Paola Canevini  3   4 , Sara Casciato  5 , Emanuele Cerulli Irelli  6 , Valentina Chiesa  3 , Filippo Dainese  7 , Giovanni De Maria  8 , Giuseppe Didato  9 , Giancarlo Di Gennaro  5 , Giovanni Falcicchio  10 , Martina Fanella  6 , Edoardo Ferlazzo  11 , Massimo Gangitano  12 , Angela La Neve  10 , Oriano Mecarelli  6 , Elisa Montalenti  13 , Alessandra Morano  6 , Federico Piazza  14 , Chiara Pizzanelli  15   16 , Patrizia Pulitano  6 , Federica Ranzato  17 , Eleonora Rosati  18 , Laura Tassi  19 , Carlo Di Bonaventura  6 ; BRIVAracetam add-on First Italian netwoRk Study (BRIVAFIRST) Group
Collaborators, Affiliations

Brivaracetam as Early Add-On Treatment in Patients with Focal Seizures: A Retrospective, Multicenter, Real-World Study

Simona Lattanzi et al. Neurol Ther. 2022 Dec.

Abstract

Introduction: In randomized controlled trials, add-on brivaracetam (BRV) reduced seizure frequency in patients with drug-resistant focal epilepsy. Most real-world research on BRV has focused on refractory epilepsy. The aim of this analysis was to assess the 12-month effectiveness and tolerability of adjunctive BRV when used as early or late adjunctive treatment in patients included in the BRIVAracetam add-on First Italian netwoRk Study (BRIVAFIRST).

Methods: BRIVAFIRST was a 12-month retrospective, multicenter study including adult patients prescribed adjunctive BRV. Effectiveness outcomes included the rates of sustained seizure response, sustained seizure freedom, and treatment discontinuation. Safety and tolerability outcomes included the rate of treatment discontinuation due to adverse events (AEs) and the incidence of AEs. Data were compared for patients treated with add-on BRV after 1-2 (early add-on) and ≥ 3 (late add-on) prior antiseizure medications.

Results: A total of 1029 patients with focal epilepsy were included in the study, of whom 176 (17.1%) received BRV as early add-on treatment. The median daily dose of BRV at 12 months was 125 (100-200) mg in the early add-on group and 200 (100-200) in the late add-on group (p < 0.001). Sustained seizure response was reached by 97/161 (60.3%) of patients in the early add-on group and 286/833 (34.3%) of patients in the late add-on group (p < 0.001). Sustained seizure freedom was achieved by 51/161 (31.7%) of patients in the early add-on group and 91/833 (10.9%) of patients in the late add-on group (p < 0.001). During the 1-year study period, 29 (16.5%) patients in the early add-on group and 241 (28.3%) in the late add-on group discontinued BRV (p = 0.001). Adverse events were reported by 38.7% and 28.5% (p = 0.017) of patients who received BRV as early and late add-on treatment, respectively.

Conclusion: Brivaracetam was effective and well tolerated both as first add-on and late adjunctive treatment in patients with focal epilepsy.

Keywords: Antiseizure medication; Brivaracetam; Epilepsy; Focal seizures.

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Figures

Fig. 1
Fig. 1
Sustained seizure response and sustained seizure freedom with brivaracetam according to early-add on treatment
Fig. 2
Fig. 2
Time to sustained seizure response with brivaracetam according to early-add on treatment
Fig. 3
Fig. 3
Time to sustained seizure freedom with brivaracetam according to early-add on treatment
Fig. 4
Fig. 4
Sustained seizure response according to the number of lifetime antiseizure medications
Fig. 5
Fig. 5
Sustained seizure freedom according to the number of lifetime antiseizure medications
See this image and copyright information in PMC

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