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Park H, Ahn H, Jang HN, Kim HJ, Yum MS, Ko TS. Efficacy and Tolerability of Low-Dose Perampanel in Patients with Childhood-Onset Intractable Epilepsy. ANNALS OF CHILD NEUROLOGY 2019. [DOI: 10.26815/acn.2019.00164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Gaudio E, Gienapp AJ, Wheless J. Perampanel Pharmacokinetics in Children: Correlation of Dose With Serum Concentrations. J Child Neurol 2019; 34:427-431. [PMID: 30909831 DOI: 10.1177/0883073819837465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Enzyme-inducing antiseizure drugs taken concomitantly with perampanel are known to influence perampanel serum concentrations. In this study, we examined perampanel dosage, serum concentrations, and the effect of concomitant enzyme-inducing antiseizure drugs in children for a 3-year period. A retrospective chart review determined patient age, weight, perampanel serum concentration and prescribed dose, and concomitant drugs. Of 87 patients included in the study, 41 were prescribed an enzyme-inducing antiseizure drug. Although perampanel dosage did not differ between patients prescribed/not prescribed enzyme-inducing antiseizure drugs, serum concentrations were significantly lower in patients taking enzyme-inducing antiseizure drugs (average serum concentration for the enzyme-inducing antiseizure drug group was still above the previously reported efficacious serum concentration of 70 ng/mL). Although perampanel serum concentrations are negatively influenced by enzyme-inducing antiseizure drugs in children, it is likely that efficacy would be improved in patients not concomitantly prescribed enzyme-inducing antiseizure drugs because pediatric perampanel dosing is similar to that reported in prior adult efficacy trials.
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Affiliation(s)
| | - Andrew J Gienapp
- 2 Le Bonheur Children's Hospital Neuroscience Institute, Memphis, TN, USA.,3 Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - James Wheless
- 2 Le Bonheur Children's Hospital Neuroscience Institute, Memphis, TN, USA.,4 Division of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
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Clinical profiles associated with serum perampanel concentrations in children with refractory epilepsy. Epilepsy Behav 2019; 94:82-86. [PMID: 30897534 DOI: 10.1016/j.yebeh.2019.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/02/2019] [Accepted: 02/04/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Perampanel (PER) is a new antiepileptic drug (AED) with a novel mechanism of action. Investigations of the efficacy and safety of PER in pediatric and adult patients have increased recently. Although the clinical usefulness and pharmacokinetics of PER have been investigated in adolescent and adult populations, similar studies have not been performed in children. PATIENTS AND METHODS We retrospectively reviewed the medical records of patients treated with PER for more than 6 months in the Department of Pediatrics, Hiroshima University Hospital, between September 2016 and November 2018. We obtained demographic and clinical data including age, sex, epilepsy type, seizure type, seizure frequency before and after treatment initiation, adverse events, reasons for discontinuing PER treatment, doses at evaluation points, serum concentrations, concomitant AEDs, intellectual status, and epilepsy etiology. Seizure types and epilepsy syndromes were classified according to the criteria of the International League Against Epilepsy. RESULTS The study included 44 patients (22 males) between the ages of 6 months and 16 years. Of those, 10 patients discontinued PER therapy. The 50% response rate was 52.3% in patients treated with PER, and four patients achieved complete seizure control. Perampanel was highly effective in patients with generalized and focal epilepsy (50% responder rates, 52.9% and 50.0%, respectively). Favorable response rates were observed for tonic-clonic, focal nonmotor, and absence seizures with 50% response rates of 54.5%, 50.0%, and 66.7%, respectively. The 50% responder rate was 31.3 for epileptic spasms (ES). Treatment-emergent adverse events (TEAEs) included somnolence (n = 8), irritability (n = 2), ataxia (n = 2), and one case each of dizziness, compulsiveness, and enuresis. Serum concentrations of PER were compared in patients taking concomitant enzyme-inducing antiepileptic drugs (EIAEDs; carbamazepine, phenytoin, and phenobarbital) and those taking concomitant non-EIAEDs. Serum PER concentrations were correlated with dose per body weight in both groups (EIAED: r = 0.765, p = 0.00000212; non-EIAED: r = 0.71, p = 0.0000158). The mean concentration-to-dose (CD) ratio was 2398.4 ng mL-1 mg-1 kg-1 (range: 800-4524.7) in the non-EIAED group and 693.7 ng mL-1 mg-1 kg-1 (range: 344-1309.7) in the EIAED group. Serum PER levels were lower in the EIAED group than in the non-EIAED group. All patients with serum PER concentrations above 400 ng/mL experienced somnolence. CONCLUSIONS Perampanel is effective against various types of seizures, including ES, in pediatric patients with refractory epilepsy. Furthermore, PER has good tolerability when the dose is adjusted based on serum concentrations. The PER CD ratio was lower in pediatric patients than in adolescents and adults; therefore, clinicians must consider the CD ratio when treating children with PER.
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Perampanel-induced weight gain depends on level of intellectual disability and its serum concentration. Epilepsy Res 2019; 152:1-6. [PMID: 30852339 DOI: 10.1016/j.eplepsyres.2019.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/28/2019] [Accepted: 02/24/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Body weight (BW) gain may be induced by perampanel (PER) administration, similar to the well-known adverse effects of valproic acid and gabapentin. Intellectual disability (ID) and serum PER concentration may be risk factors of BW gain. PURPOSE This study investigated how ID and serum PER concentration are associated with PER-induced BW gain. METHODS Subjects were 76 patients with epilepsy (41 men, aged 16-70 years). All patients were divided by intelligence quotient (IQ) into no ID (IQ ≥ 70, n = 24), mild to moderate ID (70 > IQ ≥35, n = 31), and severe to profound ID (IQ < 35, n = 21) groups. BW was measured before and 2, 4, 6, and 12 months after initiation of PER treatment, and serum PER concentration at 12 months. RESULTS BW gains in the mild to moderate ID group at 4, 6, and 12 months were significantly (p < 0.05) higher than in the no ID and in the severe to profound ID groups. At 12 months, BW gain was associated with serum PER concentrations in the no ID (p = 0.034) and the mild to moderate ID (p = 0.001) groups but not in the severe to profound ID group. Multiple linear regression analysis found BW gain at 12 months was positively correlated with the mild to moderate ID group (β = 0.373, p = 0.002) and serum PER concentration (β = 0.241, p = 0.047). CONCLUSIONS The mild to moderate ID group gained more BW than the no ID group, suggesting that PER-induced food intake was greater due to weaker behavioral control in the mild to moderate ID group. The present study suggests a linear correlation between serum PER concentration and BW change.
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Inoue Y, Kaneko S, Hsieh PF, Meshram C, Lee SA, Aziz ZA, Nabangchang C, Dash A. A post hoc analysis of the long-term safety and efficacy of perampanel in Asian patients with epilepsy. Epilepsia 2019; 60 Suppl 1:60-67. [PMID: 30869167 DOI: 10.1111/epi.14645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 12/13/2018] [Accepted: 12/18/2018] [Indexed: 11/28/2022]
Abstract
This post hoc analysis assessed the long-term safety, tolerability, and efficacy of perampanel in Asian patients with refractory focal seizures; an additional analysis assessed the effect of perampanel on focal impaired awareness seizures (FIAS) with focal to bilateral tonic-clonic (FBTC) seizures. In this subanalysis, data from Asian patients ≥12 years of age who had focal seizures with FBTC seizures despite taking one to 3 concomitant antiepileptic drugs at baseline, and who had entered either the long-term extension phase of 3 phase-3 perampanel trials (study 307) or the 10-week extension phase of study 335, were analyzed for the effect of perampanel on duration of exposure, safety, and seizure outcomes. Of 874 Asian patients included in the analysis, 205 had previously received placebo during the double-blind phase-3 trials and 669 had previously received perampanel 2-12 mg/day; 313 had FIAS with FBTC seizures at core study baseline. The median duration of exposure to perampanel was 385.0 days, and the retention rate at one year was 62.6%. Overall, during the first 52 weeks of perampanel treatment, 777 patients (88.9%) had treatment-emergent adverse events (TEAEs), most of which were mild to moderate in severity. The most frequent TEAEs were dizziness (47.1%), somnolence (22.3%), and nasopharyngitis (17.4%). During the first 52 weeks of perampanel treatment, median percent change in seizure frequency per 28 days from pre-perampanel baseline for all focal seizures was -28.1%, and -51.7% for FIAS with FBTC seizures. The 50% responder rate relative to pre-perampanel baseline for all focal seizures was 33.8%, and 51.1% for FIAS with FBTC seizures. Long-term treatment with perampanel in Asian patients had safety, tolerability, and efficacy similar to that of the global population in the phase-3 trials and extension study 307. The safety profile and response rate suggest benefit for an Asian population of patients with refractory epilepsy.
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Affiliation(s)
- Yushi Inoue
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Sunao Kaneko
- North Tohoku Epilepsy Center, Minato Hospital, Hachinohe, Japan
| | | | | | | | | | - Charcrin Nabangchang
- Comprehensive Epilepsy Center, Phramongkutklao College of Medicine, Bangkok, Thailand
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Marvanova M. Perampanel-induced, new-onset food aversion in a 29-year-old female with medically refractory frontal lobe epilepsy. Ment Health Clin 2019; 9:100-104. [PMID: 30842918 PMCID: PMC6398359 DOI: 10.9740/mhc.2019.03.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Perampanel is a selective, noncompetitive amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid glutamate receptor antagonist indicated for management of partial-onset and primary generalized seizures in epilepsy patients aged ≥12 years. PATIENT HISTORY A 29-year-old, white female with significant history of medically refractory frontal lobe epilepsy, status post right frontal and temporal resections, was initiated on perampanel as an add-on therapy to phenytoin extended-release (330 mg/d) and clonazepam (2.5 mg/d). She previously failed several antiepileptic drugs because of inefficacy and/or intolerance. Perampanel was initiated at 2 mg/d and the dose was increased by 2 mg/d increments every 2 to 3 weeks. Following the first dose, nausea and drowsiness were reported but resolved the following day. Three days after titration to 6 mg/d, the patient developed complete food aversion and became more irritable and anxious while no seizure frequency improvement was noted. No change of sense of taste was reported. After reduction to 4 mg/d, adverse effects improved but did not completely resolve until 2 months following perampanel discontinuation. REVIEW OF LITERATURE A PubMed search revealed no published literature or case reports of perampanel-induced food aversion or anorexia in a presence or absence of phenytoin and clonazepam. CONCLUSION In this report, a temporal relationship was observed between perampanel dose-increase and the development of food aversion. Return to baseline appetite and eating habits following perampanel discontinuation strongly suggest perampanel involvement. At this time, the exact mechanism(s) behind food aversion associated with perampanel is/are unknown.
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Abstract
BACKGROUND It is well-known that the pharmacokinetics of various drugs are influenced by inflammation. This study evaluated the relationship between C-reactive protein (CRP; an inflammation marker) and the pharmacokinetics of perampanel. METHODS Among 111 patients who underwent measurement of both CRP and perampanel, 23 patients had a serum CRP level exceeding 1.5 mg/dL (CRP-positive). We compared the concentration/dose ratio (CD ratio) of perampanel in these 23 patients between the times when they were CRP-positive and CRP-negative. To evaluate the effect of CRP on the CD ratio, multiple regression analysis was performed with the following covariates: CRP-positive status, body weight, and use of phenytoin, carbamazepine, or phenobarbital, and combinations of these drugs. RESULTS In 10 patients using enzyme-inducing antiepileptic drugs (AEDs), the mean CD ratio increased by 53.5% [from 1389 to 2132 (ng/mL)/(mg/kg)] when they were CRP-positive. In 13 patients without enzyme-inducing AEDs, the mean CD ratio increased by 100.8% [from 3826 ng/mL to 7683 (ng/mL)/(mg/kg)] when they were CRP-positive. By multiple regression analysis, the CRP level was a significant independent determinant of the CD ratio of perampanel. Despite a marked increase of the CD ratio, no adverse events were reported. CONCLUSIONS Irrespective of concomitant administration of enzyme-inducing AEDs, the serum perampanel concentration showed a marked increase in patients with inflammation. However, this increase was not associated with central nervous system toxicity. Although it is unknown whether the concentration of free and/or bound perampanel was increased, it seems likely that dose reduction is unnecessary for elevation of the serum perampanel level in patients with inflammation.
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Potential protein-binding displacement interactions with perampanel: An in vitro analysis. Epilepsy Res 2019; 149:102-106. [DOI: 10.1016/j.eplepsyres.2018.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/27/2018] [Accepted: 12/10/2018] [Indexed: 11/18/2022]
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Yun Y, Kim D, Lee YJ, Kwon S, Hwang SK. Efficacy and tolerability of adjunctive perampanel treatment in children under 12 years of age with refractory epilepsy. KOREAN JOURNAL OF PEDIATRICS 2018; 62:269-273. [PMID: 30590000 PMCID: PMC6642925 DOI: 10.3345/kjp.2018.06863] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/26/2018] [Indexed: 02/08/2023]
Abstract
Purpose There is limited data on the use of perampanel in children under 12 years of age. We evaluated the efficacy and tolerability of adjunctive perampanel treatment in children under 12 years of age with refractory epilepsy. Methods This retrospective observational study was performed in Kyungpook National University Hospital from July 2016 to March 2018. A responder was defined as a patient with ≥50% reduction in monthly seizure frequency compared with the baseline. Adverse events and discontinuation data were obtained to evaluate tolerability. Results Twenty-two patients (8 males, 14 females) aged 3.1–11.4 years (mean, 8.0±2.5 years) were included in this study. After an average of 9.2 months (range, 0.5–19 months) of follow-up, 15 patients (68%) showed a reduction in seizure frequency, including 5 patients (23%) with seizure freedom. The age at epilepsy onset was significantly lower (P=0.048), and the duration of epilepsy was significantly longer (P=0.019) in responders than in nonresponders. Nine patients (41%) experienced adverse events, including somnolence (23%), respiratory depression (9%), violence (4.5%), and seizure aggravation (4.5%). The most serious adverse event was respiratory depression, which required mechanical ventilation in 2 patients (9%). Eight patients (36%) discontinued perampanel due to lack of efficacy or adverse events. Three out of 4 patients (75%) who discontinued perampanel due to adverse events had an underlying medical condition. Conclusion Perampanel offers a treatment option for refractory epilepsy in children. Adjunctive treatment with perampanel requires special consideration in those with underlying medical conditions to prevent serious adverse events.
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Affiliation(s)
- Yuni Yun
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu , Korea
| | - Dongsub Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun-Jeong Lee
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu , Korea
| | - Soonhak Kwon
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu , Korea
| | - Su-Kyeong Hwang
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu , Korea
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de Biase S, Gigli GL, Nilo A, Romano G, Valente M. Pharmacokinetic and pharmacodynamic considerations for the clinical efficacy of perampanel in focal onset seizures. Expert Opin Drug Metab Toxicol 2018; 15:93-102. [PMID: 30577702 DOI: 10.1080/17425255.2019.1560420] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Medical therapy is the mainstay of management of epilepsy. Despite the increasing number of available antiepileptic drugs (AEDs), approximately one-third of epileptic patients do not have adequate control of seizures. There is still a need for the development of new AEDs with enhanced effectiveness and tolerability. Areas covered: The present manuscript is based on an Internet and PubMed search (January 2005 to August 2018). It is focused on pharmacokinetic and clinical data of perampanel (PER) for the treatment of epilepsy. Expert opinion: PER has a novel mechanism of action, which opens up new options for a rational combination therapy. Phase III trials have demonstrated the efficacy and safety of PER as adjunctive therapy for the treatment of partial-onset seizures (POS) and primary generalized tonic-clonic seizures in patients aged ≥12 years. PER is also approved by FDA as monotherapy for the treatment of POS. A clinical trial is ongoing to verify the efficacy and safety of PER monotherapy in untreated patients with POS. In the future, head-to-head comparisons are needed to determine the exact position of PER relative to other AEDs. Moreover, further studies are needed to evaluate the efficacy and safety of PER in patients aged <12 years. ABBREVIATIONS 4βOHC: 4β-hydroxycholesterol; AUC: area under the curve; CBZ: Carbamazepine; CLCr: creatinine clearance; Cmax: maximum plasma concentration; CYP: cytochrome P; EIAED: enzyme-inducing antiepileptic drug; EMA: European Medicines Agency; FDA: Food and Drug Administration; GI: gastrointestinal; OXC: oxcarbazepine; PER: perampanel; PGTC: primary generalized tonic-clonic; PHT: phenytoin; POS: partial-onset seizures; QD: once-daily; TEAE: treatment-emergent adverse event; Tmax: median time to reach peak concentration; UGT: uridine diphosphoglucose-glucuronosyltransferase; VPA: valproic acid.
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Affiliation(s)
- Stefano de Biase
- a Neurology Unit, Department of Neurosciences , University Hospital of Udine , Udine , Italy
| | - Gian Luigi Gigli
- a Neurology Unit, Department of Neurosciences , University Hospital of Udine , Udine , Italy.,b DMIF , University of Udine , Udine , Italy
| | - Annacarmen Nilo
- a Neurology Unit, Department of Neurosciences , University Hospital of Udine , Udine , Italy
| | - Giorgia Romano
- c Pediatric Unit , University Hospital of Udine , Udine , Italy
| | - Mariarosaria Valente
- a Neurology Unit, Department of Neurosciences , University Hospital of Udine , Udine , Italy.,d Department of Medicine , University of Udine Medical School , Udine , Italy
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Usui N, Akamatsu N, Nakasato N, Ohnishi A, Kaneko S, Hiramatsu H, Saeki K, Miyagishi H, Inoue Y. Long-term tolerability, safety and efficacy of adjunctive perampanel in the open-label, dose-ascending Study 231 and extension Study 233 in Japanese patients with epilepsy. Seizure 2018; 62:26-32. [DOI: 10.1016/j.seizure.2018.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/12/2018] [Accepted: 09/14/2018] [Indexed: 12/14/2022] Open
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Lin KL, Lin JJ, Chou ML, Hung PC, Hsieh MY, Chou IJ, Lim SN, Wu T, Wang HS. Efficacy and tolerability of perampanel in children and adolescents with pharmacoresistant epilepsy: The first real-world evaluation in Asian pediatric neurology clinics. Epilepsy Behav 2018; 85:188-194. [PMID: 30032806 DOI: 10.1016/j.yebeh.2018.06.033] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/09/2018] [Accepted: 06/17/2018] [Indexed: 12/25/2022]
Abstract
AIM This study investigated the efficacy and safety of perampanel (PER) adjunctive therapy in pediatric patients with epilepsy whose seizures are pharmacoresistant to existing antiepileptic drugs. METHODS A clinical retrospective study was conducted from 2016 to 2017 in the pediatric neurology clinic at a tertiary children's hospital. We reviewed the data obtained from 66 children whose seizures were pharmacoresistant to more than two antiepileptic drugs, and could be followed up for a minimum of 3 months after PER adjunctive therapy initiation. The efficacy was estimated by the PER response rate at 3-, 6-, and 12-month follow-up evaluations, and adverse events were also recorded. RESULTS The rate of seizure reduction of >50% was 30.3%, 37.5%, and 34.7% for all seizure types at 3, 6, and 12 months, in which 7.6%, 8.9%, and 14.3% of the patients became seizure-free at these time points, respectively. No significant differences were found between enzyme-inducing and nonenzyme-inducing antiepileptic drugs in combination with PER with regard to the responder rate. Five patients with Dravet syndrome were included in the study. Four of them (80%) exhibited 50% seizure reduction at the last visit, at which point, two patients (40.0%) were seizure-free. The retention rate was 51% at 12 months. Adverse events were documented in 25 patients (35.7%) and led to PER discontinuation in eight patients (12.1%). The most common adverse events comprised irritability, skin rash, dizziness, and somnolence; however, all were transient and successfully managed after PER dose reduction or discontinuation. CONCLUSION The current data support the value of adjunctive PER in child and adolescent patients with pharmacoresistant epilepsy in daily clinical practice. Perampanel was efficacious and generally well-tolerated as an add-on treatment for epilepsy.
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Affiliation(s)
- Kuang-Lin Lin
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jainn-Jim Lin
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Division of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Liang Chou
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Po-Cheng Hung
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Meng-Ying Hsieh
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - I-Jun Chou
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Siew-Na Lim
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tony Wu
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Huei-Shyong Wang
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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A Liquid Chromatography-Mass Spectrometry Assay for Determination of Perampanel and Concomitant Antiepileptic Drugs in the Plasma of Patients With Epilepsy Compared With a Fluorescent HPLC Assay. Ther Drug Monit 2018; 40:477-485. [DOI: 10.1097/ftd.0000000000000531] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Contin M, Bisulli F, Santucci M, Riva R, Tonon F, Mohamed S, Ferri L, Stipa C, Tinuper P. Effect of valproic acid on perampanel pharmacokinetics in patients with epilepsy. Epilepsia 2018; 59:e103-e108. [PMID: 29897632 DOI: 10.1111/epi.14446] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2018] [Indexed: 01/27/2023]
Abstract
We prospectively examined the effect of antiepileptic (AED) cotherapy on steady state plasma concentrations of perampanel (PMP) in epileptic patients. We classified AEDs as strong enzyme inducers (carbamazepine, phenobarbital, phenytoin, oxcarbazepine), not strong enzyme inducers/not inhibitors (levetiracetam, lamotrigine, topiramate, rufinamide, lacosamide, zonisamide, clobazam), and enzyme inhibitors (valproic acid [VPA]). The main outcome was the comparison of PMP plasma concentration to weight-adjusted dose ratio (C/D; [μg/mL]/mg kg-1 d-1 ) among comedication subgroups. From 79 patients (42 females, 37 males) aged (mean ± standard deviation) 33 ± 13 years (range = 12-66 years), 114 plasma samples were collected. Twenty-eight patients (44 samples) were cotreated with enzyme inducers (group A), 21 (27 samples) with not strong enzyme inducers/not inhibitors (group B), 21 (31 samples) with not strong enzyme inducers/not inhibitors + VPA (group C), and 9 (12 samples) with enzyme inducers + VPA (group D). PMP C/D was reduced (-56%, P < .001) in group A (1.79 ± 0.80) versus group B (4.05 ± 2.16) and increased (P < .001) in group C (6.72 ± 4.04) compared with groups A (+275%), B (+66%), and D (2.76 ± 2.00, +143%). Our study documents the unpublished higher PMP C/D in patients cotreated with VPA. These findings have both theoretical relevance, suggesting better characterization of PMP metabolic pathways with ad hoc studies, and clinical usefulness in managing patients on AED polytherapy.
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Affiliation(s)
- Manuela Contin
- Institute of Research and Treatment (IRCCS), Institute of Neurological Sciences of Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Francesca Bisulli
- Institute of Research and Treatment (IRCCS), Institute of Neurological Sciences of Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Margherita Santucci
- Institute of Research and Treatment (IRCCS), Institute of Neurological Sciences of Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Roberto Riva
- Institute of Research and Treatment (IRCCS), Institute of Neurological Sciences of Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Francesca Tonon
- Institute of Research and Treatment (IRCCS), Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Susan Mohamed
- Institute of Research and Treatment (IRCCS), Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Lorenzo Ferri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Carlotta Stipa
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paolo Tinuper
- Institute of Research and Treatment (IRCCS), Institute of Neurological Sciences of Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Tabuchi H, Shiba S, Yasuda S, Ohnishi A, Shin JG. Pharmacokinetics of Perampanel in Healthy Korean, White, and Japanese Adult Subjects. Clin Pharmacol Drug Dev 2018; 7:613-620. [DOI: 10.1002/cpdd.581] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/26/2018] [Indexed: 11/06/2022]
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Therapeutic Drug Monitoring for Perampanel in Japanese Epilepsy Patients: Influence of Concomitant Antiepileptic Drugs. Ther Drug Monit 2018; 39:446-449. [PMID: 28703720 DOI: 10.1097/ftd.0000000000000416] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Perampanel is a new antiepileptic drug (AED) that acts as a noncompetitive α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA) receptor antagonist and is mainly metabolized by cytochrome P450 (CYP) 3A4. This study evaluated the influence of concomitant AEDs on the serum concentration profile of perampanel. METHODS A total of 215 serum samples obtained from 76 patients aged 12 years or older were analyzed for routine therapeutic drug monitoring, and the concentration-to-dose ratio (CD ratio) of perampanel was compared among patients on various AED regimens. RESULTS In patients not taking concomitant enzyme-inducing AEDs, the mean CD ratio was 3963 ng·mL·mg·kg (range: 1793-13,299). By contrast, the mean CD ratio was lower in patients using enzyme-inducing AEDs [1760 (range: 892-3090), 2256 (range: 700-4703), and 1120 (range: 473-1853) ng·mL·mg·kg in patients taking phenytoin, phenobarbital, and carbamazepine, respectively], and carbamazepine had a significantly greater reduction in the CD ratio compared with phenytoin or phenobarbital (P < 0.001). Twenty-one patients responded with ≥50% reduction of seizure frequency from baseline, and their mean serum perampanel concentration was 450 ng/mL (range: 85-1500). CONCLUSIONS There is a large interindividual variation in CD ratio of perampanel because its metabolism is highly susceptible to interactions with enzyme-inducing AEDs. Therapeutic drug monitoring could be clinically useful for determining the influence of AED CYP3A4 inducers on perampanel concentrations.
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Morano A, Fattouch J, Albini M, Casciato S, Fanella M, Basili LM, Viganò A, Manfredi M, Giallonardo AT, Di Bonaventura C. Perampanel as adjunctive therapy in highly refractory epilepsies: Real-world data from an Italian tertiary care epilepsy centre. J Neurol Sci 2018; 390:67-74. [PMID: 29801910 DOI: 10.1016/j.jns.2018.04.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/26/2018] [Accepted: 04/10/2018] [Indexed: 10/17/2022]
Abstract
Perampanel (PER) is a selective non-competitive α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptor antagonist, licensed as adjunctive therapy in focal epilepsy and primary generalized tonic-clonic seizures (pGTCSs). We performed a retrospective study on highly refractory adult patients taking PER, with 1-year follow-up. Retention rate represented the primary outcome of our work; seizure frequency reduction (≥50%), "switch rate" and proportion of adverse events (AEs) were evaluated as secondary endpoints. Eighty-nine subjects (47 females, age range: 19-78 years) were included. Seventy-three had focal epilepsy (FE), 9 generalized epilepsy and 7 epileptic encephalopathy. All patients were highly drug-resistant (medication failures: 5-17). Retention rate was 87.6%, 63% and 51.7% at 3, 6 and 12 months. Responders were 27/89 (30.3%), with 8/27 seizure-free. The number of previous treatment failures and the concomitant use of enzyme inducers negatively influenced clinical response, whereas no correlation was documented between PER dose and outcome. Responder proportion was more satisfying in structural FE than in FE of unknown etiology (33% versus 20%), and in secondarily GTCSs than focal seizures (54% vs 28%), whereas pGTCSs showed a lower reponse rate (25%). Mild-to-moderate AEs (mainly dizziness, gait disturbances and psychiatric effects) were reported by 40% of patients; serious psychiatric AEs usually occurred in subjects with psychiatric comorbidities. Our study confirms the tolerability and effectiveness of PER in highly drug-resistant patients with different epilepsy syndromes and aetiologies.
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Affiliation(s)
- Alessandra Morano
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Jinane Fattouch
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Mariarita Albini
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Sara Casciato
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Martina Fanella
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Luca Manfredi Basili
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Alessandro Viganò
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Mario Manfredi
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Anna Teresa Giallonardo
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Carlo Di Bonaventura
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy.
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Tsai JJ, Wu T, Leung H, Desudchit T, Tiamkao S, Lim KS, Dash A. Perampanel, an AMPA receptor antagonist: From clinical research to practice in clinical settings. Acta Neurol Scand 2018; 137:378-391. [PMID: 29214650 DOI: 10.1111/ane.12879] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 12/21/2022]
Abstract
Epileptic seizures are refractory to treatment in approximately one-third of patients despite the recent introduction of many newer antiepileptic drugs (AEDs). Development of novel AEDs therefore remains a high priority. Perampanel is a first-in-class non-competitive selective AMPA receptor antagonist with a unique mechanism of action. Clinical efficacy and safety of perampanel as adjunctive treatment for focal seizures with/without secondary generalization (±SG) and primary generalized tonic-clonic (PGTC) seizures have been established in five phase 3 randomized controlled trials (RCTs), and a long-term extension study, and perampanel is approved as monotherapy for focal seizures ±SG in the USA. In patients with focal seizures ±SG, add-on perampanel resulted in median percent reduction in seizure frequency 23.3%-34.5% and ≥50% responder rate 28.5%-37.6%; in PGTC seizures, these results were 76.5% and 64.2%, respectively. Efficacy among adolescents (reduction in seizure frequency 34.8%-35.6%; ≥50% responder rate 40.9%-45.0%) and elderly people (reduction in seizure frequency 12.5%-16.9%; ≥50% responder rate 22.2%-42.9%) is similar to those in adults, and results remain comparable between Asian (reduction in seizure frequency 17.3%-38.0%) and global populations. Perampanel has been extensively studied in real-world clinical practice, with similar efficacy and safety results to the RCTs (≥50% responder rate 12.8%-75.0%; adverse events of somnolence/sedation, dizziness, ataxia, and behavioral changes). Real-world observational studies suggest that perampanel tolerability can be improved by slow titration (2 mg every 2-4 weeks), and bedtime administration can mitigate somnolence and dizziness. Counseling about the potential for behavioral changes and close monitoring are recommended.
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Affiliation(s)
- J.-J. Tsai
- Department of Neurology; National Cheng Kung University Hospital and School of Medicine; National Cheng Kung University; Tainan Taiwan
| | - T. Wu
- Department of Neurology; Chang Gung Memorial Hospital; Chang Gung University; Taoyuan City Taiwan
| | - H. Leung
- Department of Medicine and Therapeutics; Faculty of Medicine; Prince of Wales Hospital; Hong Kong Hong Kong
| | - T. Desudchit
- Department of Paediatrics; King Chulalongkorn Memorial Hospital; Bangkok Thailand
| | - S. Tiamkao
- Integrated Epilepsy Research Group; Department of Medicine; Faculty of Medicine; Khon Kaen University; Khon Kaen Thailand
| | - K.-S. Lim
- Division of Neurology; Department of Medicine; Faculty of Medicine; University of Malaya; Kuala Lumpur Malaysia
| | - A. Dash
- Eisai Singapore Pte. Ltd.; Singapore
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Nishida T, Lee SK, Inoue Y, Saeki K, Ishikawa K, Kaneko S. Adjunctive perampanel in partial-onset seizures: Asia-Pacific, randomized phase III study. Acta Neurol Scand 2018; 137:392-399. [PMID: 29250772 DOI: 10.1111/ane.12883] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To evaluate the efficacy, safety, and tolerability of perampanel, a selective, non-competitive, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antagonist, as an adjunctive treatment for patients with refractory partial-onset seizures (POS) from Asia-Pacific. MATERIALS & METHODS This multicenter, randomized, double-blind, placebo-controlled trial (ClinicalTrials.gov identifier: NCT01618695) involved patients aged ≥12 years with refractory POS (receiving 1-3 antiepileptic drugs). Patients were randomized (1:1:1:1) to receive once-daily placebo or perampanel 4, 8, or 12 mg over a 6-week titration and 13-week maintenance double-blind period. Enzyme-inducing antiepileptic drugs were equally stratified between groups. The primary efficacy endpoint was percent change in POS frequency per 28 days (double-blind phase vs baseline). Other efficacy endpoints included ≥50% responder rate and seizure freedom. Treatment-emergent adverse events (TEAEs) were also monitored. RESULTS Of 710 randomized patients, seizure frequency data were available for 704 patients. Median percent changes in POS frequency per 28 days indicated dose-proportional reductions in seizure frequency: -10.8% with placebo and -17.3% (P = .2330), -29.0% (P = .0003), and -38.0% (P < .0001) with perampanel 4, 8, and 12 mg, respectively. In total, 108 (15.3%) patients discontinued treatment; 44 (6.2%) due to TEAEs. TEAEs occurring in ≥5% of patients, and reported at least twice as frequently with perampanel vs placebo, included dizziness and irritability. CONCLUSIONS Adjunctive perampanel (8 and 12 mg/d) significantly improved seizure control in patients with refractory POS. Safety and tolerability were acceptable at daily doses of perampanel 4-12 mg.
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Affiliation(s)
- T. Nishida
- National Epilepsy Center; Shizuoka Institute of Epilepsy and Neurological Disorders; Shizuoka Japan
| | - S. K. Lee
- Department of Neurology; Seoul National University Hospital; Seoul South Korea
| | - Y. Inoue
- National Epilepsy Center; Shizuoka Institute of Epilepsy and Neurological Disorders; Shizuoka Japan
| | | | | | - S. Kaneko
- North Tohoku Epilepsy Center; Minato Hospital; Aomori Japan
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Takenaka O, Ferry J, Saeki K, Laurenza A. Pharmacokinetic/pharmacodynamic analysis of adjunctive perampanel in subjects with partial-onset seizures. Acta Neurol Scand 2018; 137:400-408. [PMID: 29171002 DOI: 10.1111/ane.12874] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Explore perampanel pharmacokinetics (PK) in all subjects (aged ≥12 years) vs adolescents (aged ≥12 to ≤17 years) with partial-onset seizures (POS) and identify factors explaining between-subject variability in efficacy using a population PK/pharmacodynamic (PD) analysis. MATERIALS & METHODS Population PK analysis was performed using nonlinear mixed-effect modeling with data from phase II/III randomized, double-blind, placebo-controlled studies of adjunctive perampanel in POS. Perampanel exposure was predicted for all subjects and adolescents. Population PK/PD analyses were performed using data from phase III studies to explore the relationship between perampanel exposure and 28-day average seizure frequency and responder probability. RESULTS Pooled perampanel PK data from 1318 subjects were described by a one-compartment disposition model. In the absence of antiepileptic drugs (AEDs) affecting perampanel PK, estimated perampanel apparent clearance (CL/F) was 0.668 L/h (all subjects) and 0.682 L/h (adolescent subjects). Co-administration of carbamazepine and oxcarbazepine/phenytoin reduced perampanel exposure. Gender, Asian race (excluding Japanese or Chinese), and increasing alanine aminotransferase lowered perampanel CL/F, but differences were small and not considered clinically relevant. Adolescent outcomes were similar to the total population. Based on PK/PD data from 1748 subjects, percent reduction in 28-day average seizure frequency from baseline and responder probability increased with increasing perampanel exposure; concomitant CYP3A-inducing AEDs lowered perampanel exposure but did not impact the slope for responder probability. CONCLUSIONS These results are consistent with previous analyses but expand on these through inclusion of a larger number of patients from different ethnic groups, and demonstrate that outcomes were similar between adults and adolescents.
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Affiliation(s)
| | - J. Ferry
- Eisai Inc.; Woodcliff Lake NJ USA
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Youn SE, Kim SH, Ko A, Lee SH, Lee YM, Kang HC, Lee JS, Kim HD. Adverse Events During Perampanel Adjunctive Therapy in Intractable Epilepsy. J Clin Neurol 2018; 14:296-302. [PMID: 29971974 PMCID: PMC6031997 DOI: 10.3988/jcn.2018.14.3.296] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 02/07/2023] Open
Abstract
Background and Purpose Perampanel is the first α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA)-receptor antagonist developed to treat epilepsy. The effects of either rapid or slow dose titration on adverse events remain to be elucidated. Methods Eighty-five patients received perampanel between March 2016 and August 2016. Patients were divided into two groups according to their dosing schedule: rapid dose titration (2-mg increments at intervals of 1 to 2 weeks) and slow dose titration (2-mg increments at intervals of at least 3 weeks). Seizure frequency and adverse events were analyzed over 3 months. Results Adverse events were reported by 47 (58%) of the 81 patients analyzed, with 12 (15%) patients discontinuing perampanel due to adverse events. Common adverse events included dizziness (n=30, 37%), aggressive mood and behavior (n=19, 24%), gait disturbance (n=16, 20%), and sleep problems (n=10, 12.4%). The overall adverse events were similar in the slow-titration group (38 of 61 patients) and the rapid-titration group (8 of 20 patients, p=0.081). However, none of the 20 patients in the slow-titration group experienced gait disturbance, compared with 16 of the 61 patients in the rapid-titration group (p=0.009), while appetite change was experienced by 4 patients in the slow-titration group but only 1 in the rapid-titration group (p=0.003). No relationship was noted between adverse events and the maximum dose of perampanel (p=0.116). Sex differences were observed, with the response to perampanel being better and the rate of adverse events being higher in females (p=0.015 and p=0.046, respectively). Conclusions Slow titration of perampanel may reduce perampanel-related adverse events.
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Affiliation(s)
- Song Ee Youn
- Divison of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Hee Kim
- Divison of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ara Ko
- Divison of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Ho Lee
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Mock Lee
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hoon Chul Kang
- Divison of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Soo Lee
- Divison of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Heung Dong Kim
- Divison of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Perampanel Serum Concentrations in Adults With Epilepsy: Effect of Dose, Age, Sex, and Concomitant Anti-Epileptic Drugs. Ther Drug Monit 2017; 38:358-64. [PMID: 26727625 DOI: 10.1097/ftd.0000000000000274] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Perampanel (PMP), a noncompetitive α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) glutamate receptor antagonist, is a novel anti-epileptic drug (AED) licensed for the adjunctive treatment of focal and generalized epilepsy. There is limited information on PMP's pharmacokinetics and drug interaction characteristics with concomitant AEDs. We have investigated the effects of PMP dose, age, sex, and coprescribed AEDs on serum PMP concentrations. METHODS We used the database of a therapeutic drug monitoring unit at a tertiary epilepsy referral center to identify patients who had PMP as part of their treatment and extracted clinical information from their medical notes. Sera PMP concentrations were determined using liquid chromatography/mass spectroscopy. RESULTS In total, 160 sera from 107 patients (66 females) aged 18-70 years and weighing 40-125 kg were identified. They were prescribed a median PMP dose of 6 mg/d (range 2-12 mg/d) and were coprescribed a variety of AEDs, including enzyme-inducing [carbamazepine (CBZ) and oxcarbazepine (OXC)] and enzyme-inhibiting (valproic acid) AEDs. A linear relationship was observed between PMP dose and serum concentrations (r = 0.714, P < 0.0005). Sex and age were found not to influence PMP serum concentration. Enzyme-inducing AEDs dose-dependently decreased PMP concentrations, with CBZ and OXC decreasing mean values by 69% and 37%, respectively. In contrast, although topiramate and phenytoin also decreased mean PMP concentrations by 18% and 13%, respectively, these changes did not achieve statistical significance. CONCLUSIONS PMP exhibits a linear dose-concentration relationship, with serum PMP concentrations being age and sex independent. CBZ and OXC can significantly decrease PMP concentrations, probably through an induction of CYP3A4-mediated metabolism.
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Mohamed S, Candela C, Riva R, Contin M. Simple and rapid validated HPLC-fluorescence determination of perampanel in the plasma of patients with epilepsy. Pract Lab Med 2017; 10:15-20. [PMID: 29234708 PMCID: PMC5722279 DOI: 10.1016/j.plabm.2017.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 10/26/2022] Open
Abstract
We present a simple and fast high-performance liquid chromatography method with fluorescence detection for the determination of the antiepileptic drug perampanel in human plasma. The chromatographic separation was performed on a Kinetex PFP (100 × 2.6 mm, 4.6 µm) column, using a mobile phase of sodium acetate 0.03 M pH 3.7 and acetonitrile (40/60, v/v), at a flow rate of 0.8 mL/min. Total chromatography time for each run was 5 min. Sample preparation (250 µL) involved only one simple precipitation step by acetonitrile spiked with mirtazapine as internal standard. The method was validated over a concentration range of 20-1000 ng/mL and successfully applied to measure perampanel concentrations in plasma samples obtained from patients with epilepsy. This assay combines the high specificity of fluorescence detection with a very simple and fast sample pretreatment and can offer real advantages over existing methods in terms of simplicity and transferability to a therapeutic drug monitoring setting.
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Key Words
- AED, antiepileptic drug
- AMPA, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid
- Antiepileptic drugs
- CBZ, carbamazepine
- Clinical pharmacokinetics
- Epilepsy
- HPLC-F
- HPLC-F, high performance liquid chromatography-fluorescence detector
- IS, internal standard
- LLE, liquid-liquid extraction
- LLOD, lower limit of detection
- LLOQ, lower limit of quantification
- MIR, mirtazapine
- MS/MS, tandem mass spectrometer
- OXC, oxcarbazepine
- PER, perampanel
- PHT, phenytoin
- Perampanel
- QC, quality control
- TDM, therapeutic drug monitoring
- VPA, valproic acid
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Affiliation(s)
- Susan Mohamed
- IRCCS-ISNB Institute of Neurological Sciences of Bologna, Italy
| | - Carmina Candela
- IRCCS-ISNB Institute of Neurological Sciences of Bologna, Italy.,Department of Biomedical and Neuromotor Sciences University of Bologna, Bologna, Italy
| | - Roberto Riva
- IRCCS-ISNB Institute of Neurological Sciences of Bologna, Italy.,Department of Biomedical and Neuromotor Sciences University of Bologna, Bologna, Italy
| | - Manuela Contin
- IRCCS-ISNB Institute of Neurological Sciences of Bologna, Italy.,Department of Biomedical and Neuromotor Sciences University of Bologna, Bologna, Italy
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Kheloufi F, Default A, Perrouty B, Blin O, Micallef J. Perampanel-associated self-harm ideation after dosage increase. Eur J Clin Pharmacol 2017; 74:243-244. [PMID: 29128971 DOI: 10.1007/s00228-017-2348-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 10/04/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Farid Kheloufi
- Regional Pharmacovigilance Centre of Marseille Provence Corse, Department of Clinical Pharmacology and Pharmacovigilance, Assistance Publique Hôpitaux de Marseille, Marseille, France.,Service de Pharmacologie Clinique et Pharmacovigilance, Pharmacologie intégrée et Interface Clinique Industrielle, Institut des Neurosciences, CNRS 7289, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Anne Default
- Regional Pharmacovigilance Centre of Marseille Provence Corse, Department of Clinical Pharmacology and Pharmacovigilance, Assistance Publique Hôpitaux de Marseille, Marseille, France.,Service de Pharmacologie Clinique et Pharmacovigilance, Pharmacologie intégrée et Interface Clinique Industrielle, Institut des Neurosciences, CNRS 7289, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | | | - Olivier Blin
- Regional Pharmacovigilance Centre of Marseille Provence Corse, Department of Clinical Pharmacology and Pharmacovigilance, Assistance Publique Hôpitaux de Marseille, Marseille, France.,Service de Pharmacologie Clinique et Pharmacovigilance, Pharmacologie intégrée et Interface Clinique Industrielle, Institut des Neurosciences, CNRS 7289, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Joëlle Micallef
- Regional Pharmacovigilance Centre of Marseille Provence Corse, Department of Clinical Pharmacology and Pharmacovigilance, Assistance Publique Hôpitaux de Marseille, Marseille, France. .,Service de Pharmacologie Clinique et Pharmacovigilance, Pharmacologie intégrée et Interface Clinique Industrielle, Institut des Neurosciences, CNRS 7289, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France.
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Effectiveness and tolerability of Perampanel in children, adolescents and young adults with refractory epilepsy: A UK national multicentre study. Seizure 2017; 52:63-70. [PMID: 28992560 DOI: 10.1016/j.seizure.2017.08.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/18/2017] [Accepted: 08/24/2017] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Perampanel is one of the latest antiepileptic drugs (AEDs) approved for the treatment of focal and generalised epilepsy in individuals with epilepsy aged 12 years and older. There is sparse data on the use of Perampanel in children under 12. We conducted a study amongst paediatric neurologists in the United Kingdom to investigate its effectiveness and tolerability as an adjunctive therapy in children of all ages with refractory epilepsy. METHODS Data was collected via an online questionnaire sent to paediatric neurologists in the UK. Data gathered, prospective in 62 (64.5%) and retrospective in 34 (35.5%) patients, included changes in seizure frequency from baseline and unwanted effects at 3, 6 and 12 months follow-up. Only patients with a minimum follow-up of six months were included. RESULTS Ninety six patients (48 females) with refractory epilepsy from 11 of 29 tertiary centres were included. Median [IQR] (range) age was 14 years 11 months [12 years, 16 years 6 months] (11 months-24 years 5 months). Seventy three (76%) had focal epilepsy, sixteen (17%) generalised, and seven (7%) patients both generalised and focal epilepsy. The responder rate, ≥50% seizure reduction from baseline, was 19% for all seizure types at both 6 and 12 months, 19% and 24% for focal seizures, and 25% and 7% for generalised seizures at these time points respectively. The retention rate was 42% at 12 months. Treatment was discontinued due to unwanted effects in 29 (36.7%) of the 79 patients with follow-up data available up to 12 months: 30% due to challenging behaviour, 14% dizziness, and 7.6% somnolence. CONCLUSION Perampanel was fairly effective in a heterogeneous group of 96 children and adolescents with very refractory epilepsy. The rate of adverse events leading to discontinuation was considerable in this group.
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Fureman BE, Friedman D, Baulac M, Glauser T, Moreno J, Dixon-Salazar T, Bagiella E, Connor J, Ferry J, Farrell K, Fountain NB, French JA. Reducing placebo exposure in trials: Considerations from the Research Roundtable in Epilepsy. Neurology 2017; 89:1507-1515. [PMID: 28878049 DOI: 10.1212/wnl.0000000000004535] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 07/10/2017] [Indexed: 11/15/2022] Open
Abstract
The randomized controlled trial is the unequivocal gold standard for demonstrating clinical efficacy and safety of investigational therapies. Recently there have been concerns raised about prolonged exposure to placebo and ineffective therapy during the course of an add-on regulatory trial for new antiepileptic drug approval (typically ∼6 months in duration), due to the potential risks of continued uncontrolled epilepsy for that period. The first meeting of the Research Roundtable in Epilepsy on May 19-20, 2016, focused on "Reducing placebo exposure in epilepsy clinical trials," with a goal of considering new designs for epilepsy regulatory trials that may be added to the overall development plan to make it, as a whole, safer for participants while still providing rigorous evidence of effect. This topic was motivated in part by data from a meta-analysis showing a 3- to 5-fold increased rate of sudden unexpected death in epilepsy in participants randomized to placebo or ineffective doses of new antiepileptic drugs. The meeting agenda included rationale and discussion of different trial designs, including active-control add-on trials, placebo add-on to background therapy with adjustment, time to event designs, adaptive designs, platform trials with pooled placebo control, a pharmacokinetic/pharmacodynamic approach to reducing placebo exposure, and shorter trials when drug tolerance has been ruled out. The merits and limitations of each design were discussed and are reviewed here.
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Affiliation(s)
- Brandy E Fureman
- From the Research and New Therapies Program (B.E.F., K.F., J.A.F.), Epilepsy Foundation of America, Landover, MD; Department of Neurology (D.F., J.A.F.), New York University, New York; Department of Neurology (M.B.), Hôpital la Salpêtrière, APHP/ICM, University Pierre et Marie Curie, Paris, France; Cincinnati Children's Research Foundation (T.G.), OH; University of Pennsylvania (J.M.), Philadelphia; LGS Foundation (Lennox-Gastaut Syndrome) (T.D.-S.), Bohemia; Mount Sinai School of Medicine (E.B.), New York, NY; Berry Consultants LLC and University of Central Florida College of Medicine (J.C.), Orlando; Eisai Inc. (J.F.), Woodcliff Lake, NJ; and Department of Neurology (N.B.F.), University of Virginia, Charlottesville.
| | - Daniel Friedman
- From the Research and New Therapies Program (B.E.F., K.F., J.A.F.), Epilepsy Foundation of America, Landover, MD; Department of Neurology (D.F., J.A.F.), New York University, New York; Department of Neurology (M.B.), Hôpital la Salpêtrière, APHP/ICM, University Pierre et Marie Curie, Paris, France; Cincinnati Children's Research Foundation (T.G.), OH; University of Pennsylvania (J.M.), Philadelphia; LGS Foundation (Lennox-Gastaut Syndrome) (T.D.-S.), Bohemia; Mount Sinai School of Medicine (E.B.), New York, NY; Berry Consultants LLC and University of Central Florida College of Medicine (J.C.), Orlando; Eisai Inc. (J.F.), Woodcliff Lake, NJ; and Department of Neurology (N.B.F.), University of Virginia, Charlottesville
| | - Michel Baulac
- From the Research and New Therapies Program (B.E.F., K.F., J.A.F.), Epilepsy Foundation of America, Landover, MD; Department of Neurology (D.F., J.A.F.), New York University, New York; Department of Neurology (M.B.), Hôpital la Salpêtrière, APHP/ICM, University Pierre et Marie Curie, Paris, France; Cincinnati Children's Research Foundation (T.G.), OH; University of Pennsylvania (J.M.), Philadelphia; LGS Foundation (Lennox-Gastaut Syndrome) (T.D.-S.), Bohemia; Mount Sinai School of Medicine (E.B.), New York, NY; Berry Consultants LLC and University of Central Florida College of Medicine (J.C.), Orlando; Eisai Inc. (J.F.), Woodcliff Lake, NJ; and Department of Neurology (N.B.F.), University of Virginia, Charlottesville
| | - Tracy Glauser
- From the Research and New Therapies Program (B.E.F., K.F., J.A.F.), Epilepsy Foundation of America, Landover, MD; Department of Neurology (D.F., J.A.F.), New York University, New York; Department of Neurology (M.B.), Hôpital la Salpêtrière, APHP/ICM, University Pierre et Marie Curie, Paris, France; Cincinnati Children's Research Foundation (T.G.), OH; University of Pennsylvania (J.M.), Philadelphia; LGS Foundation (Lennox-Gastaut Syndrome) (T.D.-S.), Bohemia; Mount Sinai School of Medicine (E.B.), New York, NY; Berry Consultants LLC and University of Central Florida College of Medicine (J.C.), Orlando; Eisai Inc. (J.F.), Woodcliff Lake, NJ; and Department of Neurology (N.B.F.), University of Virginia, Charlottesville
| | - Jonathan Moreno
- From the Research and New Therapies Program (B.E.F., K.F., J.A.F.), Epilepsy Foundation of America, Landover, MD; Department of Neurology (D.F., J.A.F.), New York University, New York; Department of Neurology (M.B.), Hôpital la Salpêtrière, APHP/ICM, University Pierre et Marie Curie, Paris, France; Cincinnati Children's Research Foundation (T.G.), OH; University of Pennsylvania (J.M.), Philadelphia; LGS Foundation (Lennox-Gastaut Syndrome) (T.D.-S.), Bohemia; Mount Sinai School of Medicine (E.B.), New York, NY; Berry Consultants LLC and University of Central Florida College of Medicine (J.C.), Orlando; Eisai Inc. (J.F.), Woodcliff Lake, NJ; and Department of Neurology (N.B.F.), University of Virginia, Charlottesville
| | - Tracy Dixon-Salazar
- From the Research and New Therapies Program (B.E.F., K.F., J.A.F.), Epilepsy Foundation of America, Landover, MD; Department of Neurology (D.F., J.A.F.), New York University, New York; Department of Neurology (M.B.), Hôpital la Salpêtrière, APHP/ICM, University Pierre et Marie Curie, Paris, France; Cincinnati Children's Research Foundation (T.G.), OH; University of Pennsylvania (J.M.), Philadelphia; LGS Foundation (Lennox-Gastaut Syndrome) (T.D.-S.), Bohemia; Mount Sinai School of Medicine (E.B.), New York, NY; Berry Consultants LLC and University of Central Florida College of Medicine (J.C.), Orlando; Eisai Inc. (J.F.), Woodcliff Lake, NJ; and Department of Neurology (N.B.F.), University of Virginia, Charlottesville
| | - Emilia Bagiella
- From the Research and New Therapies Program (B.E.F., K.F., J.A.F.), Epilepsy Foundation of America, Landover, MD; Department of Neurology (D.F., J.A.F.), New York University, New York; Department of Neurology (M.B.), Hôpital la Salpêtrière, APHP/ICM, University Pierre et Marie Curie, Paris, France; Cincinnati Children's Research Foundation (T.G.), OH; University of Pennsylvania (J.M.), Philadelphia; LGS Foundation (Lennox-Gastaut Syndrome) (T.D.-S.), Bohemia; Mount Sinai School of Medicine (E.B.), New York, NY; Berry Consultants LLC and University of Central Florida College of Medicine (J.C.), Orlando; Eisai Inc. (J.F.), Woodcliff Lake, NJ; and Department of Neurology (N.B.F.), University of Virginia, Charlottesville
| | - Jason Connor
- From the Research and New Therapies Program (B.E.F., K.F., J.A.F.), Epilepsy Foundation of America, Landover, MD; Department of Neurology (D.F., J.A.F.), New York University, New York; Department of Neurology (M.B.), Hôpital la Salpêtrière, APHP/ICM, University Pierre et Marie Curie, Paris, France; Cincinnati Children's Research Foundation (T.G.), OH; University of Pennsylvania (J.M.), Philadelphia; LGS Foundation (Lennox-Gastaut Syndrome) (T.D.-S.), Bohemia; Mount Sinai School of Medicine (E.B.), New York, NY; Berry Consultants LLC and University of Central Florida College of Medicine (J.C.), Orlando; Eisai Inc. (J.F.), Woodcliff Lake, NJ; and Department of Neurology (N.B.F.), University of Virginia, Charlottesville
| | - Jim Ferry
- From the Research and New Therapies Program (B.E.F., K.F., J.A.F.), Epilepsy Foundation of America, Landover, MD; Department of Neurology (D.F., J.A.F.), New York University, New York; Department of Neurology (M.B.), Hôpital la Salpêtrière, APHP/ICM, University Pierre et Marie Curie, Paris, France; Cincinnati Children's Research Foundation (T.G.), OH; University of Pennsylvania (J.M.), Philadelphia; LGS Foundation (Lennox-Gastaut Syndrome) (T.D.-S.), Bohemia; Mount Sinai School of Medicine (E.B.), New York, NY; Berry Consultants LLC and University of Central Florida College of Medicine (J.C.), Orlando; Eisai Inc. (J.F.), Woodcliff Lake, NJ; and Department of Neurology (N.B.F.), University of Virginia, Charlottesville
| | - Kathleen Farrell
- From the Research and New Therapies Program (B.E.F., K.F., J.A.F.), Epilepsy Foundation of America, Landover, MD; Department of Neurology (D.F., J.A.F.), New York University, New York; Department of Neurology (M.B.), Hôpital la Salpêtrière, APHP/ICM, University Pierre et Marie Curie, Paris, France; Cincinnati Children's Research Foundation (T.G.), OH; University of Pennsylvania (J.M.), Philadelphia; LGS Foundation (Lennox-Gastaut Syndrome) (T.D.-S.), Bohemia; Mount Sinai School of Medicine (E.B.), New York, NY; Berry Consultants LLC and University of Central Florida College of Medicine (J.C.), Orlando; Eisai Inc. (J.F.), Woodcliff Lake, NJ; and Department of Neurology (N.B.F.), University of Virginia, Charlottesville
| | - Nathan B Fountain
- From the Research and New Therapies Program (B.E.F., K.F., J.A.F.), Epilepsy Foundation of America, Landover, MD; Department of Neurology (D.F., J.A.F.), New York University, New York; Department of Neurology (M.B.), Hôpital la Salpêtrière, APHP/ICM, University Pierre et Marie Curie, Paris, France; Cincinnati Children's Research Foundation (T.G.), OH; University of Pennsylvania (J.M.), Philadelphia; LGS Foundation (Lennox-Gastaut Syndrome) (T.D.-S.), Bohemia; Mount Sinai School of Medicine (E.B.), New York, NY; Berry Consultants LLC and University of Central Florida College of Medicine (J.C.), Orlando; Eisai Inc. (J.F.), Woodcliff Lake, NJ; and Department of Neurology (N.B.F.), University of Virginia, Charlottesville
| | - Jacqueline A French
- From the Research and New Therapies Program (B.E.F., K.F., J.A.F.), Epilepsy Foundation of America, Landover, MD; Department of Neurology (D.F., J.A.F.), New York University, New York; Department of Neurology (M.B.), Hôpital la Salpêtrière, APHP/ICM, University Pierre et Marie Curie, Paris, France; Cincinnati Children's Research Foundation (T.G.), OH; University of Pennsylvania (J.M.), Philadelphia; LGS Foundation (Lennox-Gastaut Syndrome) (T.D.-S.), Bohemia; Mount Sinai School of Medicine (E.B.), New York, NY; Berry Consultants LLC and University of Central Florida College of Medicine (J.C.), Orlando; Eisai Inc. (J.F.), Woodcliff Lake, NJ; and Department of Neurology (N.B.F.), University of Virginia, Charlottesville
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Abstract
Sodium channel blockers have been the mainstay of the pharmacological management of focal and generalised tonic-clonic seizures for more than 70 years. The focus of this paper will be on phenytoin, carbamazepine, lamotrigine, oxcarbazepine, rufinamide, lacosamide and eslicarbazepine acetate. All these antiepileptic drugs have similar efficacy and share similar dose-dependent, adverse effect profiles, although phenytoin, carbamazepine and oxcarbazepine are more likely to cause idiosyncratic reactions than the others. With the exception of lamotrigine, rufinamide and lacosamide, all are enzyme inducers and most are minor teratogens; although data on teratogenicity are sparse with lacosamide and eslicarbazepine acetate. There is increasing evidence that these drugs differ mechanistically, with the newer agents, lacosamide and eslicarbazepine acetate, having their major pharmacological effect on the slow inactivation state of the sodium channel, which may be associated with better tolerability at higher dosage, although hard evidence in support of this observation is currently not available. Rufinamide is licensed only for Lennox-Gastaut syndrome in children aged 4 years and above. There is a move away from using enzyme inducers, particularly phenytoin and carbamazepine, in everyday clinical practice. There seems little doubt, however, that some sodium channel blockers will have an enduring place in the management of epilepsy well into the 21st century.
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Affiliation(s)
- Martin J Brodie
- Epilepsy Unit, West Glasgow ACH-Yorkhill, Dalnair Street, Glasgow, G3 8SJ, Scotland, UK.
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Gidal BE, Maganti R, Laurenza A, Yang H, Verbel DA, Schuck E, Ferry J. Effect of enzyme inhibition on perampanel pharmacokinetics: Why study design matters. Epilepsy Res 2017; 134:41-48. [PMID: 28535410 DOI: 10.1016/j.eplepsyres.2017.04.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 03/23/2017] [Accepted: 04/22/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Perampanel, a selective, noncompetitive AMPA receptor antagonist, is indicated as adjunctive therapy for the treatment of partial seizures with or without secondarily generalized seizures and primary generalized tonic-clonic seizures in patients with epilepsy aged 12years and older. In vitro studies and Phase I trials indicate that perampanel is metabolized almost exclusively by CYP3A, with an elimination half-life (t1/2) averaging approximately 105h. Understanding of pharmacokinetic (PK) interactions-enzyme inhibition or induction-and anticipating their occurrence are important for management of patients with epilepsy. Here we report PK results from a Phase I drug-drug interaction (DDI) study (Study 005) combining perampanel with the CYP3A inhibitor ketoconazole, as well as supplementary in silico predictions further exploring this interaction. METHODS A Phase I, randomized, open-label, two-period, two-treatment, two-way crossover study was conducted in 26 healthy adult male volunteers. Subjects were randomized to 1 of 2 treatment sequences. In one period, subjects received a single 1-mg fasting dose of perampanel (Day1); in the other period, subjects received ketoconazole 400mg once daily for 10days with a single 1-mg perampanel dose while fasting (Day3). Blood samples were drawn at multiple time points up to 288h after the perampanel dose. Pharmacokinetic parameters of perampanel were calculated by noncompartmental analysis, and safety was recorded. An integrated, physiologically based PK model built in Simcyp® provided additional insight into this interaction. Drug-drug interaction intensity was measured by the ratio of systemic exposure (area under plasma concentration-time curve [AUC]) of perampanel in the presence or absence of concomitant ketoconazole. RESULTS Single oral doses of 1mg perampanel and once-daily oral doses of ketoconazole 400mg were safe and well tolerated. Maximum perampanel plasma concentration (Cmax) and time to Cmax showed no apparent differences when perampanel was administered alone versus with ketoconazole. Ketoconazole co-administration resulted in an approximate 20% increase in perampanel AUC (P<0.001). This increase, although statistically significant, was a<2.0-fold AUC change and alone would suggest a modest effect of ketoconazole. To further explore these results, DDI simulations were performed to query the findings and test additional study conditions. Using the actual trial conditions of Study 005, the simulations also predicted an AUC ratio increase <2-fold, providing verification of the simulation assumptions and the modest effect of ketoconazole for 10days. Simulations further suggested that an interaction effect of ketoconazole on perampanel exposure (>2-fold) of potential clinical significance could be predicted when using larger doses of ketoconazole (e.g., 200mg every 6h) coadministered for a greater time period (e.g., 30days), with AUC ratio as high as 3.36. Additionally, simulations suggested that a significant interaction with co-administration of perampanel and an inhibitor more potent than ketoconazole (such as itraconazole) could not be ruled out. CONCLUSIONS Selecting an appropriate study design is critical to fully characterize the PK interaction for drugs such as perampanel that have a long t1/2. Although a negligible effect on perampanel PK was observed following co-administration of ketoconazole 400mg/day for 10days, this is likely due in part to the relatively brief co-administration period of ketoconazole and perampanel (<3 times the t1/2 of perampanel). While short-term administration of a CYP3A inhibitor may not significantly increase perampanel exposure, such increases may be expected following chronic and larger dosing or with a more potent inhibitor.
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Affiliation(s)
- Barry E Gidal
- School of Pharmacy, University of Wisconsin, Madison, WI, USA; Department of Neurology, University of Wisconsin, Madison, WI, USA.
| | - Rama Maganti
- Department of Neurology, University of Wisconsin, Madison, WI, USA.
| | - Antonio Laurenza
- Eisai Neurology Business Unit, Eisai Inc., Woodcliff Lake, NJ, USA.
| | - Haichen Yang
- Former Employee of Eisai Inc., Woodcliff Lake, NJ, USA.
| | | | - Edgar Schuck
- Eisai Clinical Pharmacology, Eisai Inc., Woodcliff Lake, NJ, USA.
| | - Jim Ferry
- Eisai Clinical Pharmacology, Eisai Inc., Woodcliff Lake, NJ, USA.
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80
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Brodie MJ, Besag F, Ettinger AB, Mula M, Gobbi G, Comai S, Aldenkamp AP, Steinhoff BJ. Epilepsy, Antiepileptic Drugs, and Aggression: An Evidence-Based Review. Pharmacol Rev 2017; 68:563-602. [PMID: 27255267 PMCID: PMC4931873 DOI: 10.1124/pr.115.012021] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Antiepileptic drugs (AEDs) have many benefits but also many side effects, including aggression, agitation, and irritability, in some patients with epilepsy. This article offers a comprehensive summary of current understanding of aggressive behaviors in patients with epilepsy, including an evidence-based review of aggression during AED treatment. Aggression is seen in a minority of people with epilepsy. It is rarely seizure related but is interictal, sometimes occurring as part of complex psychiatric and behavioral comorbidities, and it is sometimes associated with AED treatment. We review the common neurotransmitter systems and brain regions implicated in both epilepsy and aggression, including the GABA, glutamate, serotonin, dopamine, and noradrenaline systems and the hippocampus, amygdala, prefrontal cortex, anterior cingulate cortex, and temporal lobes. Few controlled clinical studies have used behavioral measures to specifically examine aggression with AEDs, and most evidence comes from adverse event reporting from clinical and observational studies. A systematic approach was used to identify relevant publications, and we present a comprehensive, evidence-based summary of available data surrounding aggression-related behaviors with each of the currently available AEDs in both adults and in children/adolescents with epilepsy. A psychiatric history and history of a propensity toward aggression/anger should routinely be sought from patients, family members, and carers; its presence does not preclude the use of any specific AEDs, but those most likely to be implicated in these behaviors should be used with caution in such cases.
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Affiliation(s)
- Martin J Brodie
- Epilepsy Unit, West Glasgow Ambulatory Care Hospital-Yorkhill, Glasgow, Scotland (M.J.B.); East London National Health Service Foundation Trust, Bedford, United Kingdom (F.B.); University College London School of Pharmacy, London, United Kingdom (F.B.); Winthrop University Hospital, Mineola, New York (A.B.E.); Epilepsy Group, Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals National Health Service Foundation Trust, London, United Kingdom (M.M.); Institute of Medical and Biomedical Sciences, St. George's, University of London, London, United Kingdom (M.M.); Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Montreal, Quebec, Canada (G.G., S.C.); McGill University Health Center, McGill University, Montreal, Quebec, Canada (G.G., S.C.); Division of Neuroscience, San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (S.C.); Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands (A.P.A.); Maastricht University Medical Centre, Maastricht, The Netherlands (A.P.A.); and Kork Epilepsy Centre, Kehl-Kork, Germany (B.J.S.)
| | - Frank Besag
- Epilepsy Unit, West Glasgow Ambulatory Care Hospital-Yorkhill, Glasgow, Scotland (M.J.B.); East London National Health Service Foundation Trust, Bedford, United Kingdom (F.B.); University College London School of Pharmacy, London, United Kingdom (F.B.); Winthrop University Hospital, Mineola, New York (A.B.E.); Epilepsy Group, Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals National Health Service Foundation Trust, London, United Kingdom (M.M.); Institute of Medical and Biomedical Sciences, St. George's, University of London, London, United Kingdom (M.M.); Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Montreal, Quebec, Canada (G.G., S.C.); McGill University Health Center, McGill University, Montreal, Quebec, Canada (G.G., S.C.); Division of Neuroscience, San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (S.C.); Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands (A.P.A.); Maastricht University Medical Centre, Maastricht, The Netherlands (A.P.A.); and Kork Epilepsy Centre, Kehl-Kork, Germany (B.J.S.)
| | - Alan B Ettinger
- Epilepsy Unit, West Glasgow Ambulatory Care Hospital-Yorkhill, Glasgow, Scotland (M.J.B.); East London National Health Service Foundation Trust, Bedford, United Kingdom (F.B.); University College London School of Pharmacy, London, United Kingdom (F.B.); Winthrop University Hospital, Mineola, New York (A.B.E.); Epilepsy Group, Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals National Health Service Foundation Trust, London, United Kingdom (M.M.); Institute of Medical and Biomedical Sciences, St. George's, University of London, London, United Kingdom (M.M.); Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Montreal, Quebec, Canada (G.G., S.C.); McGill University Health Center, McGill University, Montreal, Quebec, Canada (G.G., S.C.); Division of Neuroscience, San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (S.C.); Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands (A.P.A.); Maastricht University Medical Centre, Maastricht, The Netherlands (A.P.A.); and Kork Epilepsy Centre, Kehl-Kork, Germany (B.J.S.)
| | - Marco Mula
- Epilepsy Unit, West Glasgow Ambulatory Care Hospital-Yorkhill, Glasgow, Scotland (M.J.B.); East London National Health Service Foundation Trust, Bedford, United Kingdom (F.B.); University College London School of Pharmacy, London, United Kingdom (F.B.); Winthrop University Hospital, Mineola, New York (A.B.E.); Epilepsy Group, Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals National Health Service Foundation Trust, London, United Kingdom (M.M.); Institute of Medical and Biomedical Sciences, St. George's, University of London, London, United Kingdom (M.M.); Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Montreal, Quebec, Canada (G.G., S.C.); McGill University Health Center, McGill University, Montreal, Quebec, Canada (G.G., S.C.); Division of Neuroscience, San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (S.C.); Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands (A.P.A.); Maastricht University Medical Centre, Maastricht, The Netherlands (A.P.A.); and Kork Epilepsy Centre, Kehl-Kork, Germany (B.J.S.)
| | - Gabriella Gobbi
- Epilepsy Unit, West Glasgow Ambulatory Care Hospital-Yorkhill, Glasgow, Scotland (M.J.B.); East London National Health Service Foundation Trust, Bedford, United Kingdom (F.B.); University College London School of Pharmacy, London, United Kingdom (F.B.); Winthrop University Hospital, Mineola, New York (A.B.E.); Epilepsy Group, Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals National Health Service Foundation Trust, London, United Kingdom (M.M.); Institute of Medical and Biomedical Sciences, St. George's, University of London, London, United Kingdom (M.M.); Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Montreal, Quebec, Canada (G.G., S.C.); McGill University Health Center, McGill University, Montreal, Quebec, Canada (G.G., S.C.); Division of Neuroscience, San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (S.C.); Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands (A.P.A.); Maastricht University Medical Centre, Maastricht, The Netherlands (A.P.A.); and Kork Epilepsy Centre, Kehl-Kork, Germany (B.J.S.)
| | - Stefano Comai
- Epilepsy Unit, West Glasgow Ambulatory Care Hospital-Yorkhill, Glasgow, Scotland (M.J.B.); East London National Health Service Foundation Trust, Bedford, United Kingdom (F.B.); University College London School of Pharmacy, London, United Kingdom (F.B.); Winthrop University Hospital, Mineola, New York (A.B.E.); Epilepsy Group, Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals National Health Service Foundation Trust, London, United Kingdom (M.M.); Institute of Medical and Biomedical Sciences, St. George's, University of London, London, United Kingdom (M.M.); Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Montreal, Quebec, Canada (G.G., S.C.); McGill University Health Center, McGill University, Montreal, Quebec, Canada (G.G., S.C.); Division of Neuroscience, San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (S.C.); Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands (A.P.A.); Maastricht University Medical Centre, Maastricht, The Netherlands (A.P.A.); and Kork Epilepsy Centre, Kehl-Kork, Germany (B.J.S.)
| | - Albert P Aldenkamp
- Epilepsy Unit, West Glasgow Ambulatory Care Hospital-Yorkhill, Glasgow, Scotland (M.J.B.); East London National Health Service Foundation Trust, Bedford, United Kingdom (F.B.); University College London School of Pharmacy, London, United Kingdom (F.B.); Winthrop University Hospital, Mineola, New York (A.B.E.); Epilepsy Group, Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals National Health Service Foundation Trust, London, United Kingdom (M.M.); Institute of Medical and Biomedical Sciences, St. George's, University of London, London, United Kingdom (M.M.); Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Montreal, Quebec, Canada (G.G., S.C.); McGill University Health Center, McGill University, Montreal, Quebec, Canada (G.G., S.C.); Division of Neuroscience, San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (S.C.); Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands (A.P.A.); Maastricht University Medical Centre, Maastricht, The Netherlands (A.P.A.); and Kork Epilepsy Centre, Kehl-Kork, Germany (B.J.S.)
| | - Bernhard J Steinhoff
- Epilepsy Unit, West Glasgow Ambulatory Care Hospital-Yorkhill, Glasgow, Scotland (M.J.B.); East London National Health Service Foundation Trust, Bedford, United Kingdom (F.B.); University College London School of Pharmacy, London, United Kingdom (F.B.); Winthrop University Hospital, Mineola, New York (A.B.E.); Epilepsy Group, Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals National Health Service Foundation Trust, London, United Kingdom (M.M.); Institute of Medical and Biomedical Sciences, St. George's, University of London, London, United Kingdom (M.M.); Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Montreal, Quebec, Canada (G.G., S.C.); McGill University Health Center, McGill University, Montreal, Quebec, Canada (G.G., S.C.); Division of Neuroscience, San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (S.C.); Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands (A.P.A.); Maastricht University Medical Centre, Maastricht, The Netherlands (A.P.A.); and Kork Epilepsy Centre, Kehl-Kork, Germany (B.J.S.)
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81
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Development and Validation of an HPLC-UV Assay for the Therapeutic Monitoring of the New Antiepileptic Drug Perampanel in Human Plasma. Ther Drug Monit 2016; 38:744-750. [DOI: 10.1097/ftd.0000000000000350] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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82
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Leppik IE, Yang H, Williams B, Zhou S, Fain R, Patten A, Bibbiani F, Laurenza A. Analysis of falls in patients with epilepsy enrolled in the perampanel phase III randomized double-blind studies. Epilepsia 2016; 58:51-59. [DOI: 10.1111/epi.13600] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2016] [Indexed: 01/14/2023]
Affiliation(s)
- Ilo E. Leppik
- Department of Neurology and College of Pharmacy; University of Minnesota; Minneapolis Minnesota U.S.A
| | - Haichen Yang
- Formerly of Eisai Inc.; Woodcliff Lake New Jersey U.S.A
| | - Betsy Williams
- Eisai Medical and Scientific Affairs; Eisai Inc.; Woodcliff Lake New Jersey U.S.A
| | - Sharon Zhou
- Eisai Medical and Scientific Affairs; Eisai Inc.; Woodcliff Lake New Jersey U.S.A
| | - Randi Fain
- Formerly of Eisai Inc.; Woodcliff Lake New Jersey U.S.A
| | | | - Francesco Bibbiani
- Eisai Neuroscience and General Medicine PCU; Eisai Inc.; Woodcliff Lake New Jersey U.S.A
| | - Antonio Laurenza
- Eisai Neuroscience and General Medicine PCU; Eisai Inc.; Woodcliff Lake New Jersey U.S.A
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Pharmacokinetics, exposure–cognition, and exposure–efficacy relationships of perampanel in adolescents with inadequately controlled partial-onset seizures. Epilepsy Res 2016; 127:126-134. [DOI: 10.1016/j.eplepsyres.2016.08.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 07/11/2016] [Accepted: 08/21/2016] [Indexed: 11/23/2022]
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Villanueva V, Garcés M, López-González F, Rodriguez-Osorio X, Toledo M, Salas-Puig J, González-Cuevas M, Campos D, Serratosa J, González-Giráldez B, Mauri J, Camacho J, Suller A, Carreño M, Gómez J, Montoya J, Rodríguez-Uranga J, Saiz-Diaz R, González-de la Aleja J, Castillo A, López-Trigo J, Poza J, Flores J, Querol R, Ojeda J, Giner P, Molins A, Esteve P, Baiges J. Safety, efficacy and outcome-related factors of perampanel over 12 months in a real-world setting: The FYDATA study. Epilepsy Res 2016; 126:201-10. [DOI: 10.1016/j.eplepsyres.2016.08.001] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 07/18/2016] [Accepted: 08/03/2016] [Indexed: 01/05/2023]
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85
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Rohracher A, Kalss G, Leitinger M, Granbichler C, Deak I, Dobesberger J, Kuchukhidze G, Thomschewski A, Höfler J, Trinka E. Two-year real-world experience with perampanel in patients with refractory focal epilepsy: Austrian data. Ther Adv Neurol Disord 2016; 9:445-453. [PMID: 27800020 DOI: 10.1177/1756285616661115] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The aim of this study was to analyse registry data of seizure outcome and adverse events (AEs) for perampanel as add-on therapy in patients with focal epilepsy since its approval in 2012 for adjunctive treatment of focal epilepsy in patients ⩾12 years. METHOD A retrospective 2-year chart review of all patients receiving perampanel was carried out. RESULTS A total of 122 patients received perampanel [median treatment length: 20.1 (range: 3.4-26.8) months]; 71 (58%) remained on treatment at last follow up. Overall, 33 patients (27%) were seizure-free for ⩾3 months at last follow up; of these, eight were seizure free for ⩾3 times the longest interictal interval before perampanel therapy; 18 (15%) had reduced seizure frequency ⩾50%. A total of 58 (47%) had an AE and 34 (28%) withdrew from treatment because of AEs. AEs included dizziness (33%), fatigue (12%), psychiatric symptoms (8%), cognitive deficits (7%), speech problems (5%), nausea (4%) and gait problems (4%). AEs subsided in 17/18 patients (94%) following a 2 mg dose reduction. A total of 43 (35%) took a concomitant enzyme inducer. Patients not taking enzyme inducers were more likely to be seizure free (p = 0.002); there were no other between-group differences. CONCLUSIONS Perampanel was well tolerated and improved seizure control in 42% of patients (50- 100% reduction), with higher rates in those not receiving a concomitant enzyme inducer. AEs, particularly dizziness, were common but often disappeared with a slight dose reduction. The results are consistent with those from randomized controlled trials.
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Affiliation(s)
- Alexandra Rohracher
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Ignaz-Harrer-Straße 79, A-5020 Salzburg, Austria
| | - Gudrun Kalss
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Markus Leitinger
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Claudia Granbichler
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Ildiko Deak
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Judith Dobesberger
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Aljoscha Thomschewski
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Julia Höfler
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
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86
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Abstract
Perampanel (Fycompa®), an orally-active, selective, noncompetitive α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antagonist, is a first-in-class antiepileptic drug (AED) offering the convenience of once-daily administration. In the EU and US, perampanel is approved in patients with epilepsy aged ≥12 years for the adjunctive treatment of primary generalized tonic-clonic seizures (GTCS) and partial-onset seizures (POS; with or without secondary generalization). In phase III trials of 17 or 19 weeks' duration, add-on perampanel ≤12 mg/day significantly improved seizure control in patients aged ≥12 years who were experiencing either primary GTCS or POS (with or without secondary generalization), despite ongoing treatment with stable dosages of one to three AEDs. Improvements in seizure control were maintained for up to 2 years in extensions of these core studies. Perampanel also provided sustained seizure control for up to ≈4 years in an extension of two phase II studies in patients aged ≥18 years with drug-resistant POS. Adjunctive perampanel therapy was generally well tolerated. Treatment-emergent adverse events were most commonly CNS-related (e.g. dizziness, somnolence, fatigue and irritability) and dose-related; however, most were of mild to moderate intensity. Clinical experience with perampanel is accumulating, although comparative studies and pharmacoeconomic data that could assist in positioning it relative to other AEDS that are approved and/or recommended as adjunctive therapy are lacking. Nonetheless, on the basis of its overall clinical profile and unique mechanism of action, perampanel is a useful additional adjunctive treatment option for patients with drug-resistant POS, with or without secondary generalization, and primary GTCS.
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Affiliation(s)
- James E Frampton
- Springer, Private Bag 65901, Mairangi Bay 0754, Auckland, New Zealand.
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87
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Majid O, Laurenza A, Ferry J, Hussein Z. Impact of perampanel on pharmacokinetics of concomitant antiepileptics in patients with partial-onset seizures: pooled analysis of clinical trials. Br J Clin Pharmacol 2016; 82:422-30. [PMID: 27038098 PMCID: PMC4972158 DOI: 10.1111/bcp.12951] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/07/2016] [Accepted: 03/26/2016] [Indexed: 12/25/2022] Open
Abstract
Aims To evaluate the impact of perampanel and demographics on clearance of concomitant antiepileptic drugs (AEDs), in patients with refractory partial‐onset seizures. Methods Pooled data from three Phase III clinical studies with adjunctive perampanel were used. Blood samples for evaluation of 11 concomitant AEDs were taken during baseline (before perampanel initiation), and at weeks 10, 14, and 19 during the maintenance phase of perampanel treatment (2–12 mg/day, once daily at bedtime). Models estimating apparent clearance of each concomitant AED were fitted to the data, and the effects of perampanel and demographic variables on clearance were determined. Final models were assessed with goodness of fit plots including population predictions and individual predictions against observations. Results No significant impact of perampanel on clearance was found for clonazepam (n = 81), levetiracetam (n = 330), phenobarbital (n = 54), phenytoin (n = 90), topiramate (n = 226) or zonisamide (n = 93). Statistically significant, but small and not clinically relevant increases in model‐predicted clearance were detected for carbamazepine (+4.3% with 12 mg perampanel; n = 379), clobazam (+3.4% males, +7.7% females, 12 mg; n = 114), lamotrigine (+9.3%, 12 mg; n = 356), and valproic acid (+5.0%, 12 mg; n = 349). Oxcarbazepine clearance was reduced (26%; n = 200), but the clinical relevance is unclear as levels of the active metabolite (the monohydroxy derivative of oxcarbazepine) were not measured. Conclusions Population PK data show that perampanel (2–12 mg/day, once daily at bedtime) has no relevant impact on the clearance of the most commonly used concomitant AEDs.
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Affiliation(s)
- Oneeb Majid
- Clinical Pharmacology, Eisai Europe Ltd., Hatfield, Hertfordshire, UK
| | - Antonio Laurenza
- Neuroscience and General Medicine PCU, Eisai Inc., Woodcliff Lake, New Jersey, USA
| | - Jim Ferry
- Clinical Pharmacology, Eisai Inc., Woodcliff Lake, New Jersey, USA
| | - Ziad Hussein
- Clinical Pharmacology, Eisai Europe Ltd., Hatfield, Hertfordshire, UK
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88
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Trinka E, Steinhoff BJ, Nikanorova M, Brodie MJ. Perampanel for focal epilepsy: insights from early clinical experience. Acta Neurol Scand 2016; 133:160-72. [PMID: 26506904 PMCID: PMC4738453 DOI: 10.1111/ane.12529] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2015] [Indexed: 12/25/2022]
Abstract
Perampanel is approved for adjunctive therapy of focal epilepsy with or without secondarily generalized seizures in patients aged >12 years. This narrative review uses real-world and clinical trial data to elucidate perampanel's role in the clinic. Audit data show good tolerability with perampanel and higher freedom-from-seizure rates in elderly vs younger patients. When using perampanel in elderly patients, special attention should be given to comorbidities and co-medication to avoid potential interactions or adverse events. Slower titration is generally recommended, and seizure control should be reassessed at a dose of 4 mg before further dose increases. Perampanel efficacy is similar in adolescents and adults; however, somnolence, nasopharyngitis, and aggression are more frequent in adolescents vs the overall population. Individualized and slow-dose titration can minimize adverse events. Low serum concentrations of perampanel may occur in patients also receiving some enzyme-inducing anti-epileptic drugs; a perampanel dose increase may be required. Adverse events of importance with perampanel include dizziness; anger, aggression, and hostile behavior (particularly in adolescents); and falls (particularly in patients >65 years). An individualized approach to dosing, including slower up-titration and bedtime dosing, reduces dizziness risk. Other drugs may cause or aggravate dizziness; reducing concomitant drugs may be necessary when up-titrating perampanel. It would seem clinically appropriate to give due consideration to avoiding use in patients with a history of anger or hostile/aggressive behavior. The possibility of such behaviors should be discussed with patients before starting perampanel, with monitoring during up-titration. Slower up-titration of perampanel in older patients helps reduce fall risk.
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Affiliation(s)
- E. Trinka
- Department of Neurology Christian Doppler Medical at the Paracelsus Medical University Salzburg Centre for Cognitive Neuroscience Salzburg Austria
| | | | - M. Nikanorova
- Children's Department Danish Epilepsy Centre Dianalund Denmark
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89
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Brodie MJ, Stephen LJ. Prospective audit with adjunctive perampanel: Preliminary observations in focal epilepsy. Epilepsy Behav 2016; 54:100-3. [PMID: 26700063 DOI: 10.1016/j.yebeh.2015.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 11/02/2015] [Indexed: 01/04/2023]
Abstract
PURPOSE Perampanel (PER) was first licensed in the United Kingdom in 2012 for the adjunctive treatment of focal seizures with or without secondary generalization in adults and children over 12years of age. It has recently also been approved for use as add-on therapy for patients with primary generalized tonic-clonic seizures. This prospective audit reports preliminary outcomes with adjunctive PER in patients with focal-onset seizures in everyday clinical practice using a standard design. METHODS To date, 54 patients (38 males, 16 females; 21-65years, median: 48years) have completed the study. The median monthly seizure frequency was 4 (range: 1-60). At baseline, patients were taking a median of 2 other antiepileptic drugs (range: 1-4 drugs), with their seizures having previously failed to improve on a median of 3 schedules (range: 1-15 schedules). After 12weeks of stable dosing, PER was added, aiming at a target range of 6-12mg/daily. Review took place every 6-8weeks until one of 4 endpoints was reached: seizure freedom for ≥6months on a given PER dose, ≥50% (responder) or <50% (marginal effect) seizure reduction over 6months, compared with the prospective baseline, on the highest tolerated PER dose, or withdrawal of PER due to a lack of efficacy or side effects. RESULTS Three (5.6%) patients have remained seizure-free, with 8 (14.8%) demonstrating a ≥50% response and a further 17 (31.5%) reporting a marginal effect. Of the 26 (48.1%) dropping out of PER treatment, 21 (38.9%) did so because of side effects. The commonest problems were nausea, vomiting, ataxia, dizziness, and sedation. Overall, 6 (11%) patients developed neuropsychiatric problems, with 3 reporting irritability and/or aggression. Two patients had substantial weight gain, and another patient suffered recurrent falls. Treatment with enzyme-inducing AEDs had no effect on PER dosing in patients responding to PER or withdrawing due to side effects. SIGNIFICANCE These data support the value of adjunctive PER in some patients with pharmacoresistant epilepsy in everyday clinical practice.
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90
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Glauser T, Laurenza A, Yang H, Williams B, Ma T, Fain R. Efficacy and tolerability of adjunct perampanel based on number of antiepileptic drugs at baseline and baseline predictors of efficacy: A phase III post-hoc analysis. Epilepsy Res 2016; 119:34-40. [DOI: 10.1016/j.eplepsyres.2015.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/09/2015] [Accepted: 11/13/2015] [Indexed: 01/07/2023]
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91
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Oi N, Tokunaga M, Suzuki M, Nagai Y, Nakatani Y, Yamamoto N, Maeda J, Minamimoto T, Zhang MR, Suhara T, Higuchi M. Development of Novel PET Probes for Central 2-Amino-3-(3-hydroxy-5-methyl-4-isoxazolyl)propionic Acid Receptors. J Med Chem 2015; 58:8444-62. [DOI: 10.1021/acs.jmedchem.5b00712] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Norihito Oi
- Tsukuba
Research Laboratories, Eisai Co., Ltd., 5-1-3 Tokodai, Tsukuba, Ibaraki 300-2635, Japan
- Molecular
Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-ku, Chiba, Chiba 263-8555, Japan
| | - Masaki Tokunaga
- Molecular
Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-ku, Chiba, Chiba 263-8555, Japan
| | - Michiyuki Suzuki
- Tsukuba
Research Laboratories, Eisai Co., Ltd., 5-1-3 Tokodai, Tsukuba, Ibaraki 300-2635, Japan
- Molecular
Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-ku, Chiba, Chiba 263-8555, Japan
| | - Yuji Nagai
- Molecular
Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-ku, Chiba, Chiba 263-8555, Japan
| | - Yosuke Nakatani
- Tsukuba
Research Laboratories, Eisai Co., Ltd., 5-1-3 Tokodai, Tsukuba, Ibaraki 300-2635, Japan
- Molecular
Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-ku, Chiba, Chiba 263-8555, Japan
| | - Noboru Yamamoto
- Tsukuba
Research Laboratories, Eisai Co., Ltd., 5-1-3 Tokodai, Tsukuba, Ibaraki 300-2635, Japan
| | - Jun Maeda
- Molecular
Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-ku, Chiba, Chiba 263-8555, Japan
| | - Takafumi Minamimoto
- Molecular
Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-ku, Chiba, Chiba 263-8555, Japan
| | - Ming-Rong Zhang
- Molecular
Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-ku, Chiba, Chiba 263-8555, Japan
| | - Tetsuya Suhara
- Molecular
Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-ku, Chiba, Chiba 263-8555, Japan
| | - Makoto Higuchi
- Molecular
Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-ku, Chiba, Chiba 263-8555, Japan
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Abstract
This article lays the background for, and discusses the practical issues surrounding, the adjunctive use of the last four antiepileptic drugs (AEDs) to be licensed for the treatment of pharmacoresistant focal seizures in the UK and elsewhere. More than 30% of adolescent and adult patients will not be fully controlled on the currently available therapeutic armamentarium. After not responding to their first three AED schedules, only a handful of patients attained seizure freedom on subsequent regimens. To optimise the response to any new AED in this setting, it is often necessary to reduce the existing drug burden. The pharmacology, tolerability and safety, and everyday use of lacosamide, eslicarbazepine acetate, retigabine (ezogabine) and perampanel will be reviewed and discussed. This will be accompanied by data from prospective audits with each drug undertaken at the Western Infirmary in Glasgow, Scotland, and a report of their successful introduction in an illustrative case. Overall, there is a large variation in the course of refractory epilepsy and the effect of AED therapy on this process seems minimal. Nevertheless, a number of patients will benefit from the introduction of each new AED, with some becoming seizure-free.
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Affiliation(s)
- Martin J Brodie
- Epilepsy Unit, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT, Scotland, UK.
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93
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Strzelczyk A, Willems LM, Willig S, Rosenow F, Bauer S. Perampanel in the treatment of focal and idiopathic generalized epilepsies and of status epilepticus. Expert Rev Clin Pharmacol 2015; 8:733-40. [DOI: 10.1586/17512433.2015.1091303] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kwan P, Brodie MJ, Laurenza A, FitzGibbon H, Gidal BE. Analysis of pooled phase III trials of adjunctive perampanel for epilepsy: Impact of mechanism of action and pharmacokinetics on clinical outcomes. Epilepsy Res 2015; 117:117-24. [PMID: 26448264 DOI: 10.1016/j.eplepsyres.2015.09.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 08/07/2015] [Accepted: 09/07/2015] [Indexed: 11/27/2022]
Abstract
AIM To further explore the impact of concomitant antiepileptic drugs (AEDs) on the efficacy and tolerability of adjunctive perampanel for focal epilepsy. METHODS Data were pooled from three phase III trials of adjunctive perampanel in patients (≥12 years of age) with refractory partial-onset seizures. Concomitant AEDs were categorized according to whether or not they were enzyme-inducing AEDs (EIAEDs; known to reduce perampanel plasma concentrations) or sodium channel blockers (SCBs). Post hoc analyses assessed the impact of co-administration of non-EIAED SCBs and the overall number of concomitant AEDs on changes in seizure frequency, 50% responder rates, rates of treatment-emergent adverse events (TEAEs), and rates of discontinuation due to TEAEs, in patients randomized to receive daily placebo or perampanel 2, 4, 8, or 12mg. RESULTS Amongst 1480 randomized and treated patients, most were receiving two or more concomitant AEDs (n=1273, 86.0%), one or more EIAEDs (n=1083, 73.2%), and/or one or more SCBs (n=1203, 81.3%) at Baseline. The magnitude of seizure reduction appeared unaffected by the presence of non-EIAED SCBs, but lower in the presence of multiple AEDs. Frequency of TEAEs did not appear to be affected by the presence of non-EIAED SCBs or multiple AEDs. CONCLUSION Beyond the known interactions between perampanel and EIAEDs, perampanel efficacy appears to be unaffected by the use of concomitant non-EIAED SCBs, but may be reduced in the presence of multiple concomitant AEDs (possibly indicative of the presence of more refractory epilepsy). Nonetheless, with careful titration to balance efficacy and tolerability, perampanel may be combined with a range of AEDs, facilitating integration into treatment plans.
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Affiliation(s)
- Patrick Kwan
- Department of Medicine, The University of Melbourne, Melbourne, Australia; Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia; The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
| | | | - Antonio Laurenza
- Eisai Neuroscience Product Creation Unit, Woodcliff Lake, NJ, USA.
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95
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Jackson CF, Makin SM, Marson AG, Kerr M. Pharmacological interventions for epilepsy in people with intellectual disabilities. Cochrane Database Syst Rev 2015; 2015:CD005399. [PMID: 26333428 PMCID: PMC9216174 DOI: 10.1002/14651858.cd005399.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The prevalence of epilepsy among people with intellectual disabilities is much higher than in the general population. Seizures in this population are often complex and refractory to treatment and antiepileptic medication may have a profound effect upon behaviour (Kerr 1997).This is an updated version of a Cochrane Review first published in Issue 3, 2007. OBJECTIVES To assess the data available from randomised controlled trials (RCTs) of the efficacy of antiepileptic drug (AED) interventions in people with epilepsy and intellectual disabilities. SEARCH METHODS For the latest update of this review, we searched the Cochrane Epilepsy Group Specialised Register (2 September 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Register of Studies Online (CRSO) (2 September 2014), MEDLINE (Ovid, 1946 to 3 September 2014) and PsycINFO (EBSCOhost, 1887 to 3 September 2014). SELECTION CRITERIA Randomised and quasi-randomised controlled trials (RCTs) of pharmacological interventions for people with epilepsy and a learning disability. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We assessed epilepsy/seizure, behavioural and cognitive outcomes, as well as quality of life and adverse effects. MAIN RESULTS We included 14 RCTs (1116 participants) in the present review. Data were heterogenous and a descriptive analysis is presented. In the majority of cases where antiepileptic drugs (AEDs) were trialled in this population, we found moderate reductions in seizure frequency in that there was a significantly higher rate of responders (reduction of 50% or more) in the treatment group compared with the placebo group, with some studies reporting a higher incidence of seizure freedom in the treatment group. In general, AEDs that are proven to be effective in the general epilepsy population are also effective for refractory epilepsy in people with intellectual disability. It is not possible to comment on the relative efficacy of medications, making clinical decisions difficult.In trial settings patients continued on treatment in the majority of cases. Placebo groups often experienced fewer adverse events. Where adverse events were experienced they appeared similar to those in the general population. The methods by which adverse events were recorded and reported appeared to be inconsistent, resulting in very large variation between studies. This is problematic as clinically relevant interpretation of these findings is limited.The quality of evidence provided in the present review is low to moderate. Additionally the majority of studies lacked or used non-reliable measures of behavioural exacerbation. However, where measured, little obvious impact on behaviour was seen in terms of behaviour disorder. AUTHORS' CONCLUSIONS This review broadly supports the use of AEDs to reduce seizure frequency in people with refractory epilepsy and intellectual disability. The evidence suggests that adverse events are similar to those in the general population and that behavioural adverse events leading to discontinuation are rare; however, other adverse effects are under-researched.
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Affiliation(s)
- Cerian F Jackson
- Institute of Translational Medicine, University of LiverpoolDepartment of Molecular and Clinical PharmacologyClinical Sciences Centre for Research and Education, Lower LaneFazakerleyLiverpoolUKL9 7LJ
| | - Selina M Makin
- The Walton Centre NHS Foundation TrustLower LaneFazakerleyLiverpoolUKL9 7LJ
| | - Anthony G Marson
- Institute of Translational Medicine, University of LiverpoolDepartment of Molecular and Clinical PharmacologyClinical Sciences Centre for Research and Education, Lower LaneFazakerleyLiverpoolUKL9 7LJ
| | - Michael Kerr
- Hadyn Ellis Building, European Cancer Stem Cell Research, Cardiff UniversityCardiffWalesUKCF24 4HQ
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96
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Dried blood spots for monitoring and individualization of antiepileptic drug treatment. Eur J Pharm Sci 2015; 75:25-39. [DOI: 10.1016/j.ejps.2015.04.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/08/2015] [Accepted: 04/09/2015] [Indexed: 11/21/2022]
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97
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Vazquez B, Yang H, Williams B, Zhou S, Laurenza A. Perampanel efficacy and safety by gender: Subanalysis of phase III randomized clinical studies in subjects with partial seizures. Epilepsia 2015; 56:e90-4. [PMID: 26096637 PMCID: PMC4744665 DOI: 10.1111/epi.13019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2015] [Indexed: 12/23/2022]
Abstract
The antiepileptic drug (AED) perampanel is approved in ≥40 countries as adjunctive therapy for drug‐resistant partial seizures in patients with epilepsy. This post hoc analysis of pooled data from three phase III, double‐blind, randomized studies of perampanel examines between‐gender differences in perampanel efficacy and safety. Of the 1,478 subjects in the pooled analysis (719 male, 759 female), 1,109 were included in the pharmacokinetic/pharmacodynamic analysis. Perampanel oral clearance was 17% lower in female than in male patients not receiving enzyme‐inducing AEDs. Pooled efficacy analysis revealed that seizure frequency was reduced with perampanel treatment regardless of gender; a greater numerical reduction in seizure frequency and increased responder rates occurred in female participants at perampanel doses of 4, 8, and 12 mg. Tolerability was similar between groups, although common adverse events such as dizziness and headache occurred more frequently in female subjects. Modest elevations in perampanel exposure in female patients may result in meaningful between‐gender differences in efficacy and safety; therefore, dosing should be individualized and clinical response monitored.
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Affiliation(s)
| | - Haichen Yang
- Eisai Neuroscience Product Creation Unit, Woodcliff Lake, New Jersey, U.S.A
| | - Betsy Williams
- Eisai Medical and Scientific Affairs, Woodcliff Lake, New Jersey, U.S.A
| | - Sharon Zhou
- Eisai Medical and Scientific Affairs, Woodcliff Lake, New Jersey, U.S.A
| | - Antonio Laurenza
- Eisai Neuroscience Product Creation Unit, Woodcliff Lake, New Jersey, U.S.A
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98
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Gidal BE, Laurenza A, Hussein Z, Yang H, Fain R, Edelstein J, Kumar D, Ferry J. Perampanel efficacy and tolerability with enzyme-inducing AEDs in patients with epilepsy. Neurology 2015; 84:1972-80. [PMID: 25878177 PMCID: PMC4433458 DOI: 10.1212/wnl.0000000000001558] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 01/28/2015] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Evaluate the impact of concomitant enzyme (CYP3A4)-inducer antiepileptic drugs (EIAEDs) on the efficacy and safety of perampanel in patients from the 3 phase-III clinical trials. METHODS Patients with pharmacoresistant partial-onset seizures in the 3 phase-III clinical studies were aged 12 years and older and receiving 1 to 3 concomitant antiepileptic drugs. Following 6-week baseline, patients were randomized to once-daily, double-blind treatment with placebo or perampanel 8 or 12 mg (studies 304 and 305) or placebo or perampanel 2, 4, or 8 mg (study 306). RESULTS Treatment response assessed by median percent reduction in seizure frequency and responder rates improved with perampanel compared with placebo. However, at 8 and 12 mg, the treatment response was significantly greater in patients receiving non-EIAEDs. The treatment effect (perampanel-placebo) also demonstrated a dose-dependent increase in all patients. The overall incidence of treatment-emergent adverse events was similar regardless of the presence of EIAEDs. Occurrence of some adverse events, such as fatigue, somnolence, dizziness, irritability, was greater in patients receiving non-EIAEDs, as was discontinuation because of adverse events. CONCLUSIONS Perampanel shows efficacy and safety in the presence and absence of EIAEDs. As systemic exposure to perampanel increases, so does efficacy. Given the extensive metabolism of perampanel, systemic exposure is clearly reduced with concomitant administration of CYP3A4 inducers. This supports the strategy of dosing perampanel to clinical effect. Recognition of these pharmacokinetic interactions will be important in the optimization of this novel medication. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that 2 to 12 mg/d doses of perampanel reduced seizure frequency and improved responder rate in the presence and absence of EIAEDs.
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Affiliation(s)
- Barry E Gidal
- From the School of Pharmacy (B.E.G.), University of Wisconsin, Madison; Eisai Neuroscience Product Creation Unit (A.L., J.F., H.Y., D.K.), Woodcliff Lake, NJ; Eisai Ltd. (Z.H.), Hatfield, UK; Eisai Medical and Scientific Affairs (R.F.), Woodcliff Lake, NJ; and formerly of Sui Generis Health (J.E.), New York, NY.
| | - Antonio Laurenza
- From the School of Pharmacy (B.E.G.), University of Wisconsin, Madison; Eisai Neuroscience Product Creation Unit (A.L., J.F., H.Y., D.K.), Woodcliff Lake, NJ; Eisai Ltd. (Z.H.), Hatfield, UK; Eisai Medical and Scientific Affairs (R.F.), Woodcliff Lake, NJ; and formerly of Sui Generis Health (J.E.), New York, NY
| | - Ziad Hussein
- From the School of Pharmacy (B.E.G.), University of Wisconsin, Madison; Eisai Neuroscience Product Creation Unit (A.L., J.F., H.Y., D.K.), Woodcliff Lake, NJ; Eisai Ltd. (Z.H.), Hatfield, UK; Eisai Medical and Scientific Affairs (R.F.), Woodcliff Lake, NJ; and formerly of Sui Generis Health (J.E.), New York, NY
| | - Haichen Yang
- From the School of Pharmacy (B.E.G.), University of Wisconsin, Madison; Eisai Neuroscience Product Creation Unit (A.L., J.F., H.Y., D.K.), Woodcliff Lake, NJ; Eisai Ltd. (Z.H.), Hatfield, UK; Eisai Medical and Scientific Affairs (R.F.), Woodcliff Lake, NJ; and formerly of Sui Generis Health (J.E.), New York, NY
| | - Randi Fain
- From the School of Pharmacy (B.E.G.), University of Wisconsin, Madison; Eisai Neuroscience Product Creation Unit (A.L., J.F., H.Y., D.K.), Woodcliff Lake, NJ; Eisai Ltd. (Z.H.), Hatfield, UK; Eisai Medical and Scientific Affairs (R.F.), Woodcliff Lake, NJ; and formerly of Sui Generis Health (J.E.), New York, NY
| | - Jacob Edelstein
- From the School of Pharmacy (B.E.G.), University of Wisconsin, Madison; Eisai Neuroscience Product Creation Unit (A.L., J.F., H.Y., D.K.), Woodcliff Lake, NJ; Eisai Ltd. (Z.H.), Hatfield, UK; Eisai Medical and Scientific Affairs (R.F.), Woodcliff Lake, NJ; and formerly of Sui Generis Health (J.E.), New York, NY
| | - Dinesh Kumar
- From the School of Pharmacy (B.E.G.), University of Wisconsin, Madison; Eisai Neuroscience Product Creation Unit (A.L., J.F., H.Y., D.K.), Woodcliff Lake, NJ; Eisai Ltd. (Z.H.), Hatfield, UK; Eisai Medical and Scientific Affairs (R.F.), Woodcliff Lake, NJ; and formerly of Sui Generis Health (J.E.), New York, NY
| | - Jim Ferry
- From the School of Pharmacy (B.E.G.), University of Wisconsin, Madison; Eisai Neuroscience Product Creation Unit (A.L., J.F., H.Y., D.K.), Woodcliff Lake, NJ; Eisai Ltd. (Z.H.), Hatfield, UK; Eisai Medical and Scientific Affairs (R.F.), Woodcliff Lake, NJ; and formerly of Sui Generis Health (J.E.), New York, NY
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99
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Schulze-Bonhage A, Hintz M. Perampanel in the management of partial-onset seizures: a review of safety, efficacy, and patient acceptability. Patient Prefer Adherence 2015; 9:1143-51. [PMID: 26316718 PMCID: PMC4542413 DOI: 10.2147/ppa.s63951] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Perampanel (PER) is a novel antiepileptic drug recently introduced for the adjunctive treatment in epilepsy patients aged 12 years or older with partial-onset seizures with or without secondary generalization in the US and Europe. Its antiepileptic action is based on noncompetitive inhibition of postsynaptic AMPA receptors, decreasing excitatory synaptic transmission. Evaluation of efficacy in three placebo-controlled randomized Phase III studies showed that add-on therapy of PER decreased seizure frequencies significantly compared to placebo at daily doses between 4 mg/day and 12 mg/day. PER's long half-life of 105 hours allows for once-daily dosing that is favorable for patient compliance with intake. Long-term extension studies showed a 62.5%-69.6% adherence of patients after 1 year of treatment, comparing favorably with other second-generation antiepileptic drugs. Whereas these trials demonstrated an overall favorable tolerability profile of PER, nonspecific central nervous system adverse effects like somnolence, dizziness, headache, and fatigue may occur. In addition, neuropsychiatric disturbances ranging from irritability to suicidality were reported in several case reports; both placebo-controlled and prospective long-term extension trials showed a low incidence of such behavioral and psychiatric complaints. For early recognition of neuropsychiatric symptoms like depression, anxiety, and aggression, slow titration and close monitoring during drug introduction are mandatory. This allows on the one hand to recognize patients particularly susceptible to adverse effects of the drug, and on the other hand to render the drug's full potential of seizure control available for the vast majority of patient groups tolerating the drug well.
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Affiliation(s)
- Andreas Schulze-Bonhage
- Epilepsy Center, University Medical Center Freiburg, Freiburg, Germany
- Correspondence: Andreas Schulze-Bonhage, Epilepsy Center, University Medical Center Freiburg, Breisacher Strasse 64, D-79106 Freiburg, Germany, Tel +49 761 2705 4250, Fax +49 761 2705 0030, Email
| | - Mandy Hintz
- Epilepsy Center, University Medical Center Freiburg, Freiburg, Germany
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100
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Mano Y, Takenaka O, Kusano K. High-performance liquid chromatography-tandem mass spectrometry method for the determination of perampanel, a novel α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor antagonist in human plasma. J Pharm Biomed Anal 2014; 107:56-62. [PMID: 25569285 DOI: 10.1016/j.jpba.2014.12.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 12/11/2014] [Accepted: 12/12/2014] [Indexed: 11/19/2022]
Abstract
Perampanel (Fycompa(®)) is a novel α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antagonist registered for the adjunctive treatment of patients (≥12 years) with refractory partial onset seizures. In order to support clinical trials, as well as therapeutic drug monitoring, a sensitive bioanalytical method for the determination of perampanel concentrations in human plasma was established and validated using liquid chromatography with tandem mass spectrometry. Perampanel and an internal standard were extracted from human plasma (100 μL) by liquid extraction using methyl t-butyl ether, then evaporated and reconstituted. The chromatographic separation was conducted on a C8 column with isocratic elution at a flow rate of 0.2 mL/min. The established method showed linearity in the range 0.25-200 ng/mL with correlation coefficients of >0.99 that could be extended 10-fold as validated by dilution integrity analyses. No significant endogenous peaks were detected in the elution of analytes in blank human plasma and no significant matrix effect was observed. The intra- and inter-batch reproducibility analyses demonstrated accuracy and precision within the acceptance criteria. To check the impact of anti-epileptic drugs on the perampanel assay, accuracy, precision, and specificity were assessed in the presence of 14 anti-epileptic drugs. No anti-epileptic drugs at clinically relevant levels showed a significant impact on the perampanel assay.
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Affiliation(s)
- Yuji Mano
- Drug Metabolism and Pharmacokinetics, Biopharmaceutical Assessment Core Function Unit, Eisai Co., Ltd., 1-3, 5-chome, Tokodai, Tsukuba-shi, Ibaraki 300-2635, Japan.
| | - Osamu Takenaka
- Drug Metabolism and Pharmacokinetics, Biopharmaceutical Assessment Core Function Unit, Eisai Co., Ltd., 1-3, 5-chome, Tokodai, Tsukuba-shi, Ibaraki 300-2635, Japan
| | - Kazutomi Kusano
- Drug Metabolism and Pharmacokinetics, Biopharmaceutical Assessment Core Function Unit, Eisai Co., Ltd., 1-3, 5-chome, Tokodai, Tsukuba-shi, Ibaraki 300-2635, Japan
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