TY  - JOUR
A1  - Strzelczyk, Adam
A1  - Zaveta, Clara
A1  - Podewils, Felix von
A1  - Möddel, Gabriel
A1  - Langenbruch, Lisa Marie
A1  - Kovać, Stjepana
A1  - Mann, Catrin
A1  - Willems, Laurent Maximilian
A1  - Schulz, Juliane
A1  - Fiedler, Barbara Judith
A1  - Kurlemann, Gerhard
A1  - Schubert-Bast, Susanne
A1  - Rosenow, Felix
A1  - Beuchat, Isabelle
T1  - Long-term efficacy, tolerability, and retention of brivaracetam in epilepsy treatment: a longitudinal multicenter study with up to 5 years of follow-up
T2  - Epilepsia
N2  - Objective: This study was undertaken to evaluate the long-term efficacy, retention, and tolerability of add-on brivaracetam (BRV) in clinical practice. Methods: A multicenter, retrospective cohort study recruited all patients who initiated BRV between February and November 2016, with observation until February 2021. Results: Long-term data for 262 patients (mean age = 40 years, range = 5–81 years, 129 men) were analyzed, including 227 (87%) diagnosed with focal epilepsy, 19 (7%) with genetic generalized epilepsy, and 16 (6%) with other or unclassified epilepsy syndromes. Only 26 (10%) patients had never received levetiracetam (LEV), whereas 133 (50.8%) were switched from LEV. The length of BRV exposure ranged from 1 day to 5 years, with a median retention time of 1.6 years, resulting in a total BRV exposure time of 6829 months (569 years). The retention rate was 61.1% at 12 months, with a reported efficacy of 33.1% (79/239; 50% responder rate, 23 patients lost-to-follow-up), including 10.9% reported as seizure-free. The retention rate for the entire study period was 50.8%, and at last follow-up, 133 patients were receiving BRV at a mean dose of 222 ± 104 mg (median = 200, range = 25–400), including 52 (39.1%) who exceeded the recommended upper dose of 200 mg. Fewer concomitant antiseizure medications and switching from LEV to BRV correlated with better short-term responses, but no investigated parameters correlated with positive long-term outcomes. BRV was discontinued in 63 (24%) patients due to insufficient efficacy, in 29 (11%) for psychobehavioral adverse events, in 25 (10%) for other adverse events, and in 24 (9%) for other reasons. Significance: BRV showed a clinically useful 50% responder rate of 33% at 12 months and overall retention of >50%, despite 90% of included patients having previous LEV exposure. BRV was well tolerated; however, psychobehavioral adverse events occurred in one out of 10 patients. Although we identified short-term response and retention predictors, we could not identify significant predictors for long-term outcomes. Key Points Long-term postmarketing data for brivaracetam in 262 patients showed an overall retention rate of 50.8%; At 12 months, the 50% responder rate for brivaracetam was 33.1%, with 10.9% reporting seizure freedom; Previous treatment with levetiracetam (90%) did not impact brivaracetam retention or efficacy; Levetiracetam treatment failure should not preclude brivaracetam introduction; No long-term efficacy predictors could be identified.
KW  - adverse events
KW  - epilepsy
KW  - levetiracetam
KW  - refractory
KW  - seizure
KW  - SV2A
Y1  - 2021
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/67560
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-675602
SN  - 1528-1167
N1  - Open access funding enabled and organized by ProjektDEAL.
N1  - A.S. reports personal fees and grants from Arvelle Therapeutics, Desitin Arzneimittel, Eisai, GW Pharmaceuticals companies,  Marinus Pharma, UCB Pharma, UNEEG medical, and Zogenix. F.v.P. reports industry-funded travel with the support of Desitin Arzneimittel, Bial, Eisai Pharma, Arvelle Therapeutics, GW  Pharmaceuticals, and UCB Pharma; and honoraria obtained for speaking engagements from Desitin Arzneimittel Zogenix, Bial,  Arvelle Therapeutics, GW Pharmaceuticals, and UCB Pharma, and  as part of a speaker's bureau for Bial, Eisai Pharma, Arvelle Therapeutics, GW Pharmaceuticals, and UCB Pharma. G.M. reports industry-funded travel support from Desitin Arzneimittel,  Eisai Pharma, and UCB Pharma, as well as speaking honoraria from UCB Pharma. L.L. reports honoraria for lecturing from  Eisai, Biogen, and GW Pharmaceuticals. S.K.reports grants from Biogen  and a grant from Deutsche Forschungsgemeinschaft. C.M. reports  speaking honoraria from Eisai. L.M.W. reports travel support  from Eisai. G.K. has obtained honoraria for speaking engagements  from Desitin Arzneimittel, Eisai, UCB Pharma, Takeda, Shire, Zogenix, Neuraxpharm, Stada, and GW Pharmaceuticals. S.S.-B. reports personal fees from UCB, Desitin Pharma, and Shire. F.R. reports personal fees from Eisai, Medtronic, Cerbomed, ViroPharma, Sandoz, BayerVital, and Shire; grants and personal fees from UCB  and Desitin Arzneimittel; personal fees and other from Novartis; and grants from the European Union and Deutsche Forschungsgemeinschaft. I.B. received a Postdoctoral Mobility Fellowship from the Swiss National Science Foundation.
VL  - 62
IS  - 12
SP  - 2994
EP  - 3004
PB  - Wiley-Blackwell
CY  - Oxford [u.a.]
ER  -