Long-Term Effectiveness of Adjunctive Brivaracetam For Previously Treated Focal Seizures

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Adjunctive brivaracetam may  provide long term effectiveness in adults who have not seen optimal results with other common treatments.
Adjunctive brivaracetam may provide long term effectiveness in adults who have not seen optimal results with other common treatments.

The following article is part of conference coverage from the American Epilepsy Society's Annual Meeting in New Orleans, LA. The Neurology Advisor's staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AES 2018.


NEW ORLEANS — Adjunctive brivaracetam (BRV) may provide long-term effectiveness in adults with adult focal seizures who have not seen optimal results with common treatments such as levetiracetam (LEV), according to research presented at the 72nd Annual Meeting of the American Epilepsy Society, held November 30-December 4, 2018. 

In this post hoc analysis of a double-blind, placebo-controlled trial and its extension, research authors analyzed data from 503 participants with focal seizures who took BRV 100 mg or 200 mg daily (pooled). Retention rates from the first dose in the double-blind trial and reasons for BRV discontinuation were evaluated in subgroups of participants who had tried but discontinued carbamazepine (CBZ), lamotrigine (LTG), LEV, or topiramate (TPM) at least 90 days before starting BRV.

Overall, Kaplan Meier analysis showed retention on BRV of 71%, 59.6%, 50.9%, 40.9%, and 32.4% at the first, second, third, fourth, and fifth years, respectively. By the time of data collection, 58.8% of participants had discontinued BRV, most often because of poor efficacy (19.3%) and adverse events (16.1%). Retention rates were consistent across the subgroups with previous CBZ, LTG, LEV, or TPM experience, ranging from 64.8% to 73.2% at 1 year, 48.1% to 60.3% at 2 years, and 41.9% to 49.9% at 3 years.

A similar percentage of patients discontinued BRV regardless of their prior subgroup (CBZ, 58.4%; LTG, 63%; LEV, 58.6%; TPM, 60.4%). Reasons for discontinuing BRV were comparable, with 23% to 25.3% discontinuing because of poor efficacy and 16.7% to 22.2% because of an adverse event. The median time to discontinuation varied: 379 days for the CBZ subgroup, 298 days for the LTG subgroup, 315 days for the LEV subgroup, 340 days in the TPM subgroup, and 370 in the BRV subgroup.

“Adjunctive BRV provides long-term effectiveness in patients who failed common [antiepileptic drug] treatments, including LEV,” researchers concluded. "This analysis supports that common AED treatment failures, including LEV, should not preclude the use of BRV to treat patients with focal seizures.”

This research was sponsored by UCB Pharma.

For more coverage of AES 2018, click here.

Reference

Martin M, Dimova S, Elmoufti S, Laloyaux C, Chung SC. Long-term retention on adjunctive brivaracetam in adults with focal seizures previously exposed to carbamazepine, lamotrigine, levetiracetam, or topiramate: a post hoc analysis. Presented at: 72nd Annual Meeting of the American Epilepsy Society; November 30-December 4, 2018; New Orleans, LA. Abstract 1.294.

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