Treatment with brivaracetam may be a potentially effective adjunct therapy in patients with drug-resistant focal or generalized epilepsies with seizures that have not previously responded to or who cannot tolerate levetiracetam, according to a study published in Epilepsy & Behavior.

Patients with epilepsy who had previously received levetiracetam and who were prescribed add-on brivaracetam were prospectively enrolled from a tertiary UK center (n=134). At the start of the data collection period, a total of 63 patients were taking levetiracetam. A total of 39 patients treated with levetiracetam were switched to brivaracetam because levetiracetam was not effective, whereas 24 patients were switched to brivaracetam because of either behavioral or psychiatric side effects of levetiracetam.

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The primary efficacy outcome of interest was the change in seizure frequency, which was evaluated with the last 3 months of follow-up data. Additionally, the proportion of 50% responders, or those with a 50% reduction in seizure frequency vs baseline, and the proportion seizure-free periods, comprised the primary outcomes of interest.

Approximately 29% of patients with focal epilepsy, 25% of patients with generalized epilepsy, and 71% of patients with combined focal and generalized epilepsy achieved a ≥50% responder rate. Patients received brivaracetam for an average of 11 months at a median dose of 200 mg.

Withdrawal of brivaracetam occurred in 37% of patients, including 16% because of lack of efficacy and 21% because of adverse events. Increased seizure frequency was reported in 11% of patients, resulting in withdrawal of brivaracetam. Somnolence, aggression, and depression were reported in 26%, 23%, and 12% of patients, respectively.

Limitations of the study include its open-label design, small sample size, and the recruitment of patients from a single center in the United Kingdom.

“Patients who have discontinued [levetiracetam] may still benefit from [brivaracetam] despite the lower than expected improvement to seizure control given the potential benefits from an adverse event perspective,” the researchers wrote.

Reference

Foo EC, Geldard J, Peacey C, Wright E, Eltayeb K, Maguire M. Adjunctive brivaracetam in focal and generalized epilepsies: a single-center open-label prospective study in patients with psychiatric comorbidities and intellectual disability. Epilepsy Behav. 2019;99:106505.