Recent Studies Elucidate the Advantages of the Newest AEDs

Clinical studies have demonstrated that adjunctive brivaracetam at doses of 100 mg and 200 mg is more effective than placebo for all outcome measures, with 50% responder rates of 38.9% and 37.8%, respectively. “Yet there does not appear to be a clear dose–response effect,” Dr. Abou-Khalil said. “In addition, the efficacy of the 20-mg and 50-mg doses is inconsistent across studies, although in a pooled analysis, the 50-mg dose was more effective than placebo.”

Generally, brivaracetam does not appear to be effective when taken concomitantly with levetiracetam. In addition, brivaracetam’s efficacy is greater in levetiracetam-naïve patients than in patients who have failed levetiracetam, but that could be because the latter patients have greater drug resistance, he added.

“Switching to brivaracetam may be a consideration for patients who have seizure control with levetiracetam, but cannot tolerate it due to adverse effects,” Dr. Abou-Khalil said. In one study, patients who switched overnight from levetiracetam 1–3 g/day to brivaracetam 200 mg/day had clinically meaningful reductions in nonpsychotic behavioral adverse events. Health-related quality of life scores were improved, as well.

In an analysis of data from three phase III trials, adjunctive brivaracetam effectively reduced the frequency of generalized tonic-clonic seizures in 409 patients, with around one-third achieving seizure freedom at 100 mg and 200 mg per day. Another study showed that brivaracetam may be more effective in patients age 65 and older than in the general population of epilepsy patients, Dr. Abou-Khalil said. In that study, the median reduction from baseline in focal seizure frequency was 14.0% for placebo versus 25.5%, 49.6%, and 74.9% for brivaracetam 50 mg/day, 100 mg/day, and 200 mg/day, respectively.

—Adriene Marshall