In:
Epilepsia, Wiley, Vol. 58, No. 7 ( 2017-07), p. 1208-1216
Abstract:
To evaluate factors predicting efficacy, retention, and tolerability of add‐on brivaracetam ( BRV ) in clinical practice. Methods A multicenter, retrospective cohort study recruiting all patients who started BRV between February and November 2016 with observation time between 3 and 12 months. Results Of a total of 262 patients (mean age 40, range 5–81 years, 129 male) treated with BRV , 227 (87%) were diagnosed to have focal, 19 (7%) idiopathic generalized and 8 (3%) symptomatic generalized epilepsy, whereas 8 (3%) were unclassified. The length of exposure to BRV ranged from 1 day to 12 months, with a median retention time of 6.1 months, resulting in a total exposure time to BRV of 1,504 months. The retention rate was 79.4% at 3 months and 75.8% at 6 months. Efficacy at 3 months was 41.2% (50% responder rate) with 14.9% seizure‐free for 3 months and, at 6 months, 40.5% with 15.3% seizure‐free. Treatment‐emergent adverse events were observed in 37.8% of the patients, with the most common being somnolence, dizziness, and behavioral adverse events ( BAEs ). BAE that presented under previous levetiracetam ( LEV ) treatment improved upon switch to BRV in 57.1% (20/35) and LEV ‐induced somnolence improved in 70.8% (17/24). Patients with BAE on LEV were more likely to develop BAE on BRV (odds ratio [ OR ] 3.48, 95% confidence interval [ CI ] 1.53–7.95). Significance BRV in broad clinical postmarketing use is a well‐tolerated anticonvulsant drug with 50% responder rates, similar to those observed in the regulatory trials, even though 90% of the patients included had previously been exposed to LEV . An immediate switch from LEV to BRV at a ratio of 10:1 to 15:1 is feasible. The only independent significant predictor of efficacy was the start of BRV in patients not currently taking LEV . The occurrence of BAE during previous LEV exposure predicted poor psychobehavioral tolerability of BRV treatment. A switch to BRV can be considered in patients with LEV ‐induced BAE .
Type of Medium:
Online Resource
ISSN:
0013-9580
,
1528-1167
DOI:
10.1111/epi.2017.58.issue-7
Language:
English
Publisher:
Wiley
Publication Date:
2017
detail.hit.zdb_id:
2002194-X
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