Introduction

Around one-third of individuals with symptomatic epilepsy may not respond adequately to antiseizure medications (ASMs). Brivaracetam is approved as an adjunctive therapy in the treatment of focal seizures, with or without secondary generalization and has shown improvements in seizure frequency in focal epilepsy patients on ASMs, whether administered as initial add-on treatment or as a later addition. However, there is paucity of data on the efficacy of brivaracetam as an adjunctive treatment for epilepsy, particularly as either the first or second option.

Aim

To evaluate the efficacy of adjunctive brivar­acetam therapy in people with epilepsy in a real-world clinical setting

Patient Profile

• 543 epilepsy patients on adjunctive bri­varacetam therapy

Method

Study Design

• Prospective, observational, multicentre study
• Adjunctive brivar­acetam was administered at dosages of 25, 50 and 100 mg BD

Endpoints

• Seizure frequency, seizure free­dom, and any worsening of seizures at both the 14th and 90th day follow-up points

Results

Efficacy

• Adjunctive brivaracetam achieved a significant seizure response (re­duction of >50% in seizure frequency versus baseline) indicating a sustained ther­apeutic effect over time (p<0.001): 51.1% at the 14-day follow-up and 63.1% at the 90-day follow-up (Figure 1)
• Treatment with adjunctive brivaracetam achieved substantial seizure freedom in 36.8% individuals at day 90 (p<0.001)
• Treatment-naive individuals exhibited higher rates of seizure response (≥50% reduction in seizure frequency) as compared with treatment-resistant individuals (80.3% vs. 46%, p<0.001)
• Seizure freedom was achieved in a greater number of treatment-resistant individuals as compared with treatment-naive individuals (54% vs. 19.7%, p<0.001)
• Brivaracetam combined with divalproex sodium was the most prevalent treatment (52% of individuals), followed by brivaracetam with levetiracetam (21% of individuals)
• Seizure worsening was minimal (0.4% experienced it at 14-day follow-up)

Figure 1: Effect of adjunctive brivaracetam on seizure response and freedom at 14 and 90 days

Conclusion

Adjunctive brivaracetam therapy was effective and safe in epilepsy man­agement in a clinical environment, with significant reductions in seizure frequency

Drugs Context. 2024; 13: 2024-3-2