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Pascarella A, Manzo L, Gasparini S, Marsico O, Abelardo D, Torino C, Cianci V, Iudice A, Bisulli F, Bonanni P, Caggia E, D'Aniello A, Di Bonaventura C, DiFrancesco JC, Domina E, Dono F, Gambardella A, Fortunato F, Marini C, Marrelli A, Matricardi S, Morano A, Paladin F, Renna R, Piccioli M, Striano P, Ascoli M, La Neve A, Le Piane E, Orsini A, Di Gennaro G, Aguglia U, Ferlazzo E. Perampanel in post-stroke epilepsy: Clinical practice data from the PERampanel as Only Concomitant antiseizure medication (PEROC) study. J Neurol Sci 2024; 462:123106. [PMID: 38925069 DOI: 10.1016/j.jns.2024.123106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/13/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Post-stroke epilepsy (PSE) is one of the most common causes of acquired epilepsy. Nevertheless, there is limited evidence regarding the clinical profile of antiseizure medications (ASMs) in PSE. This study aims to evaluate the 12-month effectiveness and tolerability of perampanel (PER) used as only add-on treatment in patients with PSE in a real-world setting. METHODS We performed a subgroup analysis of PSE patients included in a previous retrospective, longitudinal, multicentre observational study on adults. Treatment discontinuation, seizure frequency and adverse events were collected at 3, 6 and 12 months. Sub-analyses by early (≤1 previous ASM) or late PER add-on were also conducted. RESULTS Our analysis included 56 individuals with PSE, characterized by varying initial treatment modalities and timeframes relative to disease onset. We found notable retention rates (92.8%, 83.7%, and 69% at 3, 6, and 12 months), with treatment withdrawal mainly due to poor tolerability. One year after PER introduction, seizure frequency significantly reduced, with a responder rate (≥50% reduction) of 83.9% and a seizure-free rate of 51.6%. Adverse events occurred in 25 (46.3%) patients, mainly dizziness, irritability, and behavioural disorders. No major statistical differences were found between early (30 patients, 53.6%) and late add-on groups, except for a higher 6-month responder rate in the early add-on group. CONCLUSION Adjunctive PER was effective and well-tolerated in patients with PSE in a real-world setting. Perampanel demonstrated good efficacy and safety as both early and late add-on treatment, making it a compelling option for this unique patient population.
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Affiliation(s)
- Angelo Pascarella
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy
| | - Lucia Manzo
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy
| | - Oreste Marsico
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy
| | - Domenico Abelardo
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy
| | - Claudia Torino
- Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, National Research Council, Institute of Clinical Physiology, Reggio Calabria, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy
| | - Alfonso Iudice
- Department of Neurosciences, Section of Neurology, University of Pisa, Pisa, Italy
| | - Francesca Bisulli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Full Member of the European Reference Network for Rare and Complex Epilepsies (EpiCARE), Bologna, Italy
| | - Paolo Bonanni
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute, IRCCS Eugenio Medea, Treviso, Italy
| | | | | | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | | | | | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Antonio Gambardella
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Neurologic Clinic, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Francesco Fortunato
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Neurologic Clinic, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Carla Marini
- Child Neurology and Psychiatric Unit, G. Salesi Pediatric Hospital, Azienda Ospedaliera-Universitaria delle Marche, Ancona, Italy
| | - Alfonso Marrelli
- Neurophysiopathology Unit, Epilepsy Center, San Salvatore Hospital, L'Aquila, Italy
| | | | - Alessandra Morano
- Epilepsy Unit, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | | | - Rosaria Renna
- Neurological Clinic and Stroke Unit, "Cardarelli" Hospital, Naples, Italy
| | - Marta Piccioli
- UOC Neurology, PO San Filippo Neri, ASL Roma 1, Rome, Italy
| | - Pasquale Striano
- IRCCS Istituto Giannina Gaslini, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy
| | | | - Angela La Neve
- Dipartimento di Scienze Mediche di Base, Neuroscienze e Organi di Senso, Università di Bari
| | - Emilio Le Piane
- Dipartimento di Neurologia, Ospedale Pugliese-Ciaccio, Catanzaro, Italy
| | - Alessandro Orsini
- Pediatric Neurology, Pediatric Department, AOUP Santa Chiara Univeristy Hospital, Pisa, Italy
| | - Gianfranco Di Gennaro
- Dipartimento di Scienze della Salute, Scuola di Medicina, Università Magna Graecia di Catanzaro, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy.
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Punia V, Klein P, Mihaylova T, Biton V, Samad O, Ngo LY, Kumar D, Malhotra M. Perampanel as monotherapy or first adjunctive therapy in pediatric and adult patients with epilepsy: the first United States-based phase IV open-label ELEVATE study. J Neurol 2024; 271:4587-4598. [PMID: 38730096 PMCID: PMC11233369 DOI: 10.1007/s00415-024-12399-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/12/2024]
Abstract
ELEVATE (Study 410; NCT03288129) is the first prospective, multicenter, open-label, Phase IV study of perampanel as monotherapy or first adjunctive therapy in patients aged ≥ 4 years with focal-onset seizures or generalized tonic-clonic seizures in the United States. The study included Screening, Titration (≤ 13 weeks), Maintenance (39 weeks), and Follow-up (4 weeks) Periods. During Titration, perampanel was initiated at 2 mg/day and up-titrated to 4 mg/day at Week 3. Depending on response and tolerability, optional up-titrations to a maximum of 12 mg/day occurred. The primary endpoint was retention rate; additional endpoints included seizure-freedom rate, 50% responder rate, and incidence of treatment-emergent adverse events (TEAEs). At baseline, 10 (18.5%) patients were assigned to the monotherapy group and 44 (81.5%) patients to the first adjunctive therapy group. However, due to the addition of an anti-seizure medication along with perampanel on the first day of treatment, one patient was excluded from the monotherapy subgroup analyses. The mean perampanel exposure duration was 39.8 weeks and 32 (59.3%) patients completed the study. Retention rate at 12 months (or study completion) was 63.0% (monotherapy, 77.8%; first adjunctive therapy, 59.1%). Seizure-freedom rate during the Maintenance Period was 32.7% (monotherapy, 44.4%; first adjunctive therapy, 29.5%) and the 50% responder rate was 78.7% (monotherapy, 85.7%; first adjunctive therapy, 76.9%). TEAEs and serious TEAEs were reported by 88.9% (n = 48/54) and 7.4% (n = 4/54) of patients, respectively. Overall, the efficacy and safety of perampanel as monotherapy or first adjunctive therapy support the use of perampanel as early-line treatment for epilepsy.
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Affiliation(s)
- Vineet Punia
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA.
| | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA
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Ravat S, Rohatgi A, Kulkarni R, Jabeen SA, Patil B, Dash A, Malhotra M. Efficacy and Safety of adjunctive Perampanel in a prospective, real-world, Phase IV study in Indian patients aged ≥12 years for Treatment of focal-onset Epilepsy: Study 508. Epilepsia Open 2024; 9:940-950. [PMID: 38124551 PMCID: PMC11145615 DOI: 10.1002/epi4.12885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/01/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE ESPRITE (Study 508; NCT03836924) evaluated the real-world safety, tolerability, and efficacy of adjunctive perampanel in patients aged ≥12 years with focal-onset seizures (FOS), with or without focal to bilateral tonic-clonic seizures (FBTCS), in India. METHODS ESPRITE was a prospective, multicenter, single-arm, observational, Phase IV study with a 6-month Treatment Period. Patients were aged ≥12 years and had been prescribed perampanel for adjunctive treatment of FOS, with or without FBTCS. Assessments included incidence of treatment-emergent adverse events (TEAEs; primary endpoint), median percent reduction in seizure frequency per 28 days from baseline, 50% responder rates, and seizure-freedom rates. RESULTS Overall, 200 patients were enrolled (199 patients in the Safety Analysis Set and 174 patients who completed all visits in the main efficacy analyses). TEAEs (all mild or moderate in severity) were reported in 18.1% (n = 36/199) of patients (the most common were dizziness [3.0%] and irritability [2.0%]). TEAEs leading to discontinuation of perampanel were reported in 2.0% of patients; no deaths or serious TEAEs occurred. At 6 months, median percent reduction in seizure frequency was 100.0%, 50% responder rate was 83.3%, and seizure-freedom rate was 49.4%. SIGNIFICANCE Adjunctive perampanel (at a mean daily dose of 4 mg/day) was shown to be well tolerated and effective in patients aged ≥12 years with FOS, with or without FBTCS, from India. PLAIN LANGUAGE SUMMARY Many patients do not receive adequate treatment for epilepsy and need effective seizure control medications. In this 6-month clinical study, 199 patients from India, aged 12 years or older, added perampanel to the anti-seizure medications they were already taking. At 6 months, 49% of patients experienced no seizures since starting perampanel and seizure frequency was reduced by half in 83% of patients. Side effects occurred in 18% of patients (most commonly dizziness and irritability) and caused 2% to stop perampanel; no deaths were reported. Perampanel was an effective and generally safe added medication for patients with epilepsy from India.
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Affiliation(s)
| | | | - Rahul Kulkarni
- Deenanath Mangeshkar Hospital and Research CenterPuneIndia
| | - Shaik A. Jabeen
- Nizam's Institute of Medical SciencesHyderabadTelanganaIndia
| | - Balaji Patil
- Eisai Pharmaceuticals India Pvt. Ltd.MumbaiIndia
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Steinhoff BJ, Goldmann T, Kockelmann E, Winter Y. PERPRISE: A prospective non-interventional study of PERampanel as only adjunctive treatment in patients with PRImary or SEcondarily generalized tonic-clonic seizures: First interim analysis. Epilepsia Open 2024; 9:926-939. [PMID: 38017663 PMCID: PMC11145611 DOI: 10.1002/epi4.12869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/16/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE To report the interim results of the PERPRISE study (Study 509; NCT04202159), which is evaluating perampanel as the only adjunctive anti-seizure medication (ASM) in adults with focal to bilateral tonic-clonic seizures (FBTCS) or primary generalized tonic-clonic seizures (GTCS). METHODS PERPRISE is an ongoing 12-month multicenter, prospective, observational, non-interventional study of perampanel in a real-world setting in Germany. Patients are aged ≥18 years with FBTCS or GTCS due to focal or idiopathic generalized epilepsy. Perampanel, as an adjunctive therapy to ASM monotherapy ('add-on therapy') or as a substitute for one ASM in dual therapy ('substitution therapy'), is prescribed in line with its SmPC. The Interim Analysis Set comprises the first 100 patients who received ≥1 dose of perampanel and attended or discontinued prior to the ~6-month visit. Interim endpoints include retention rate, measures of effects on seizure frequency, and treatment-emergent adverse events (TEAEs). RESULTS One hundred patients were included in the Interim Analysis Set (add-on, n = 43 [43.0%]; substitution, n = 55 [55.0%]; unknown, n = 2). The 6-month retention rate was 78.0% (add-on, 83.7%; substitution, 72.7%). For the overall population with GTCS and/or FBTCS, seizure-freedom rate at 6 months was 58.8% (add-on, 72.2%; substitution, 47.9%) and 50% responder rate at 6 months was 82.6% (add-on, 89.2%; substitution, 76.6%). Retention rates and seizure outcomes were better with perampanel as an early-line treatment than as a late-line treatment. TEAEs were reported by 48 patients (48.0%), most commonly dizziness (n = 9), fatigue (n = 7), and irritability (n = 7). Sixteen patients (16.0%) withdrew from perampanel treatment due to TEAEs. SIGNIFICANCE The interim analysis of PERPRISE offers insight into the real-world use of perampanel in Germany, including for the first time, clinical practice data from patients with GTCS and switching ASMs within a dual therapy. Further data from PERPRISE will be of value to inform clinical decision-making in this patient cohort. PLAIN LANGUAGE SUMMARY Patients with epilepsy often take more than one medication for seizure control. This 12month study looked at patients in Germany receiving perampanel as only add-on medication. The interim analysis shows, that at 6 months, over 70% of the 100 patients continued to use perampanel; 59% experienced no seizures during treatment with perampanel, and in 83%, seizure frequency was reduced by half. Side effects occurred in 48% of patients (most commonly dizziness, fatigue, and irritability) and caused 16% to withdraw from the study. Overall, perampanel was a suitable as only add-on medication for patients with epilepsy.
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Affiliation(s)
- Bernhard J Steinhoff
- Kork Epilepsy CenterKehl‐KorkGermany
- Medical FacultyUniversity of FreiburgFreiburg im BreisgauGermany
| | | | | | - Yaroslav Winter
- Mainz Comprehensive Epilepsy and Sleep Medicine CenterDepartment of NeurologyUniversity Medical Center of the Johannes Gutenberg UniversityMainzGermany
- Department of NeurologyPhilipps‐University MarburgMarburgGermany
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Moretz K, Wheless J, Santos C, Segal E, Lancman M, Patten A, Malhotra M. Phase IV PROVE study: Perampanel in real-world clinical care of pediatric patients with epilepsy. Eur J Paediatr Neurol 2024; 50:23-30. [PMID: 38569352 DOI: 10.1016/j.ejpn.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 01/10/2024] [Accepted: 02/17/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION The non-interventional Phase IV PROVE study (NCT03208660) assessed retention, efficacy, safety and tolerability, and perampanel dosing in patients with epilepsy during routine clinical care. This analysis evaluated final data from patients aged <4 years and 4-<12 years. METHODS Data were obtained retrospectively from medical/pharmacy records of patients in the United States initiating perampanel after January 1, 2014, according to treating clinician recommendations. Retention rate was the primary endpoint. Secondary assessments included median percent changes in seizure frequency, seizure-freedom rates, investigator impression of seizure effect, and safety and tolerability. RESULTS The Safety Analysis Set (SAS) included 41 patients (<4 years; mean maximum dose, 3.5 mg/day) and 203 patients (4-<12 years; mean maximum dose, 5.3 mg/day); 24-month retention rates were 35.7% (n = 5/14) and 42.0% (n = 47/112), respectively. In the Full Analysis Set, during Months 1-3, median percent reductions in seizure frequency were 33.3% (n = 8 [<4 years]) and 26.0% (n = 32 [4-<12 years]), and seizure-freedom rates were 12.5% in both groups (n = 1/8 and n = 4/32); patient numbers were low at later time points. Most patients showed improvements in seizure control (45.9% [<4 years] versus 52.4% [4-<12 years]) or no change (45.9% versus 34.5%) (SAS). Treatment-emergent adverse events (TEAEs) were reported in 12 (<4 years: 29.3%; most common, irritability [7.3%]) and 64 patients (4-<12 years: 31.5%; most common, aggression [6.9%]). CONCLUSIONS Perampanel was generally well tolerated with <21% of TEAEs leading to withdrawal at 24 months, had favorable retention rates (≥50% and >35% at 12 and 24 months, respectively), and sustained efficacy in pediatric patients during routine clinical care.
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Affiliation(s)
- Katherine Moretz
- Meridian Clinical Research, LLC, 6602 Waters Avenue, Building C, Savannah, GA, 31406, USA
| | - James Wheless
- University of Tennessee Health Science Center, Le Bonheur Children's Hospital, 49 N Dunlap Street, Memphis, TN, 38105, USA.
| | - Cesar Santos
- Valley Children's Hospital, 9300 Valley Children's Place Madera, CA, 93636, USA.
| | - Eric Segal
- Northeast Regional Epilepsy Group, Hackensack University Medical Center, Hackensack Meridian School of Medicine, 30 Prospect Avenue, Hackensack, NJ 07601, USA.
| | - Marcelo Lancman
- Northeast Regional Epilepsy Group, Hackensack University Medical Center, Hackensack Meridian School of Medicine, 30 Prospect Avenue, Hackensack, NJ 07601, USA.
| | - Anna Patten
- Eisai Europe Ltd., European Knowledge Centre, Mosquito Way, Hatfield, Hertfordshire, AL10 9SN, UK.
| | - Manoj Malhotra
- Formerly: Eisai Inc., 200 Metro Blvd., Nutley, NJ, 07110, USA.
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Arai Y, Inaji M, Shimizu K, Kondo S, Hashimoto-Fujimoto S, Kiyokawa J, Kawano Y, Yamamoto S, Maehara T. Long-term efficacy and safety of perampanel as an add-on therapy in patients with epilepsy. Epilepsy Res 2024; 200:107307. [PMID: 38286107 DOI: 10.1016/j.eplepsyres.2024.107307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/26/2023] [Accepted: 01/19/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Perampanel (PER) is a newly developed amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA) receptor antagonist that has been globally approved for the treatment of both focal and generalized seizures. The efficacy and safety of PER have only been reported over short periods of treatment so far. This study aims to clarify the long-term efficacy and safety of PER as an add-on therapy. METHOD This retrospective observational study investigated 176 epilepsy patients who received PER as add-on medical therapy in two Japanese epilepsy centers between June 2016 and July 2022. The adherence, seizure frequency, and plasma concentration of PER were evaluated at three time points: 6 months, 12 months, and 24 months or longer after the start of adjunctive PER treatment. RESULTS 112 patients undergoing PER treatment were evaluated at 6 months, 86 were evaluated at 12 months, and 52 were evaluated at 24 months or longer. Overall, 42.9 % (48/112), 45.4 % (40/86), and 44.2 % (23/52) of the patients were seizure-free at 6, 12, and 24 months or longer, respectively. The rate of PER tolerance was 78.3 %, 69.9 %, and 54.7 % at 6, 12, and 24 months or longer, respectively. At the latest timepoint, the seizure-free group was taking a significantly lower dose of PER than the seizure-remnant group, and the number of anti-seizure medications (ASMs) was associated with seizure outcomes. In addition, the seizure-free rate was significantly higher in patients who received PER as a first add-on than in those who received it as a late add-on. No significant difference was found in the plasma concentration of PER between the seizure-free and seizure-remnant groups at 24 months or longer. Among the patients receiving PER at dose of 2 mg, however, the plasma concentrations were significantly higher in the seizure-free group than in the seizure-remnant group (282.7 ± 109.8 μg/ml vs 94.7 ± 54.9 μg/ml, p = 0.0024). CONCLUSION This long-term retrospective observational study provides evidence of the efficacy and safety of PER over 2 years treatment period in Japan. Notably, patients who started on PER as the first add-on showed a better seizure outcome than those who received it as a late add-on over the long term. Measured plasma concentrations may provide valuable guidance for the management of patients. Higher plasma concentration at low dose PER may suggest the better seizure control.
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Affiliation(s)
- Yukika Arai
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Kazuhide Shimizu
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shizukoto Kondo
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Juri Kiyokawa
- Department of Neurosurgery, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yoshihisa Kawano
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinji Yamamoto
- Department of Neurosurgery, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
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Zeng Y, Wu X. Efficacy and tolerability of perampanel: a Chinese real-world observational study in epilepsy. Front Neurol 2024; 14:1286276. [PMID: 38313406 PMCID: PMC10836157 DOI: 10.3389/fneur.2023.1286276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/27/2023] [Indexed: 02/06/2024] Open
Abstract
Purpose To investigate whether there exists a statistically significant distinction between the effectiveness and tolerance of perampanel (PER) and the number of antiseizure medications (ASMs) that were tried prior to administering PER. Method A prospective, observational study was performed at West China Hospital of Sichuan University. The study included patients diagnosed with epilepsy who were prescribed PER and were monitored for a minimum of 6 months. The efficacy of PER was evaluated at 1, 3, 6, and 12-month intervals by examining the retention rate and the 50% response rate. All statistical analyses were conducted using IBM SPSS Statistics version 25 (IBM Corporation, Armonk, New York). Results A total of 1,025 patients were identified, of which 836 were included in the analysis. Seven hundred and eighty-nine patients (94.4%) were followed up for a year. The median age of the patients was 29.32 ± 14.06 years, with 45.81% of the patients being male and 17.0% being adolescents. The average duration of epilepsy was 11.22 ± 8.93 years. Overall, PER was discontinued in 49.5% of patients, with the most common reasons being inadequate therapeutic effect and treatment-emergent adverse events (TEAEs). At the 6-month follow-up, the retention rate was 54.2% (454/836), and 39.6% of patients had a 50% response. At the 12-month follow-up, the retention rate was 49.4% (340/789), and 44.5% of patients had a 50% response. Patients who received PER as monotherapy had the highest retention rates (P = 0.034) and 50% response rates (P < 0.001) at any follow-up point. TEAEs were reported in 32.0% of patients, and these led to discontinuation in 15.4% of patients. The most common TEAEs were dizziness and somnolence. There was no significant difference between subgroups (P = 0.57), but there was a significant difference between the dosage of PER and TEAEs (P < 0.001). Main findings The study concludes that PER is effective in treating both focal and generalized tonic-clonic seizures. Patients who had fewer previous exposures to ASMs exhibited higher response rates to PER. TEAEs related to PER dosage were more prevalent during the first 3 months of treatment and tended to improve with continued use, ultimately demonstrating favorable long-term tolerability.
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Affiliation(s)
- Ya Zeng
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Xintong Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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Pascarella A, Gasparini S, Manzo L, Marsico O, Torino C, Abelardo D, Cianci V, Iudice A, Bisulli F, Bonanni P, Caggia E, D'Aniello A, Di Bonaventura C, DiFrancesco JC, Domina E, Dono F, Gambardella A, Marini C, Marrelli A, Matricardi S, Morano A, Paladin F, Renna R, Piccioli M, Striano P, Ascoli M, Ferlazzo E, Aguglia U. Perampanel as only add-on epilepsy treatment in elderly: A subgroup analysis of real-world data from retrospective, multicenter, observational study. J Neurol Sci 2023; 455:122797. [PMID: 37976793 DOI: 10.1016/j.jns.2023.122797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/31/2023] [Accepted: 11/12/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Drug management of epilepsy in the elderly presents unique but data on this population are scarce. This study aimed to assess the effectiveness and tolerability of perampanel (PER) used as only add-on to a background anti-seizure medication (ASM) in the elderly in a real-world setting. METHODS We performed a subgroup analysis of patients aged ≥65 years included in a previous 12-month multicenter study on adults. Treatment discontinuation, seizure frequency, and adverse events were recorded at 3, 6 and 12 months after PER introduction. Sub-analyses by early (≤1 previous ASM) or late PER add-on were also conducted. RESULTS The sample included 65 subjects (mean age: 75.7 ± 7.2 years), with mainly focal (73.8%) epilepsy. The mean PER daily dose was ≈4 mg during all follow-up. Retention rates at 3, 6, and 12 months were 90.5%, 89.6%, and 79.4%ly. The baseline median normalized per 28-day seizure number significantly decreased at 3-, 6- and 12-month visits. One year after PER introduction, the responder rate (≥50% reduction in baseline seizure frequency) was 89.7%, with a seizure freedom rate of 72.4%. Adverse events occurred in 22 (34.9%) patients with dizziness and irritability being the most frequent. No major differences between early (41 patients, 63.1%), and late add-on groups were observed. CONCLUSION Adjunctive PER was effective and well-tolerated when used as only add-on treatment in elderly people with epilepsy in clinical practice, thus representing a suitable therapeutic option in this age category.
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Affiliation(s)
- Angelo Pascarella
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli Hospital", Reggio Calabria, Italy
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli Hospital", Reggio Calabria, Italy
| | - Lucia Manzo
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli Hospital", Reggio Calabria, Italy
| | - Oreste Marsico
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli Hospital", Reggio Calabria, Italy
| | - Claudia Torino
- Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, National Council of Research, Institute of Clinical Physiology, Reggio Calabria, Italy
| | - Domenico Abelardo
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli Hospital", Reggio Calabria, Italy
| | - Alfonso Iudice
- Department of Neurosciences, Section of Neurology, University of Pisa, Pisa, Italy
| | - Francesca Bisulli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Full Member of the European Reference Network for Rare and Complex Epilepsies (EpiCARE), Bologna, Italy
| | - Paolo Bonanni
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute, IRCCS Eugenio Medea, Treviso, Italy
| | | | | | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | | | | | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Antonio Gambardella
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Neurologic Clinic, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Carla Marini
- Child Neurology and Psychiatric Unit, G. Salesi Pediatric Hospital, Azienda Ospedaliera-Universitaria delle Marche, Ancona, Italy
| | - Alfonso Marrelli
- Neurophysiopathology Unit, Epilepsy Center, San Salvatore Hospital, L'Aquila, Italy
| | | | | | | | - Rosaria Renna
- Neurological Clinic and Stroke Unit, "Cardarelli" Hospital, Naples, Italy
| | - Marta Piccioli
- UOC Neurology, PO San Filippo Neri, ASL Roma 1, Rome, Italy
| | - Pasquale Striano
- IRCCS Istituto Giannina Gaslini, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy
| | | | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli Hospital", Reggio Calabria, Italy.
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli Hospital", Reggio Calabria, Italy
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9
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Ma H, Zhu H, Chen F, Yang Y, Qu X, Xu H, Yang L, Zhang R. Efficacy and safety of perampanel monotherapy in Chinese patients with focal-onset seizures: A single-center, prospective, real-world observational study. Epilepsia Open 2023; 8:1474-1483. [PMID: 37661647 PMCID: PMC10690709 DOI: 10.1002/epi4.12823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/26/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVE Efficacy and safety of perampanel monotherapy for treating focal-onset seizures (FOS) has been barely studied in China. This observational study aimed to evaluate the efficacy and safety of perampanel monotherapy in treating Chinese patients with FOS. METHODS This single-center, prospective, real-world observational study enrolled patients aged ≥4 years with FOS who visited the Epilepsy Out-Patient Clinic of Nanjing Brain Hospital affiliated to Nanjing Medical University from January 2020 to December 2021. All patients were treated with perampanel monotherapy. Seizure-freedom rates after 6 and 12 months of treatment were calculated. Adverse events (AEs) were recorded. RESULTS Seventy patients with FOS were enrolled. The mean maintenance perampanel dose was 4.64 ± 1.55 mg/day. The 6- and 12-month retention rates of perampanel monotherapy were 78.6% (55/70) and 70.0% (49/70), respectively. The 6- and 12-month seizure-freedom rates were 69.84% (44/63) and 65.08% (41/63), respectively. Patients with focal to bilateral tonic-clonic seizures had significantly higher 6-month and numerically higher 12-month seizure freedom rates than patients with focal impaired awareness seizures (P = 0.046 and P = 0.204, respectively). Twenty-six (37.1%) patients experienced treatment-emergent AEs, and the most common AE was dizziness. Four (5.7%) patients withdrew from the study due to AEs. No new safety concern was observed. SIGNIFICANCE This is the first prospective study on the efficacy and safety of perampanel monotherapy in treating Chinese patients with FOS, and perampanel monotherapy was effective and safe in treating Chinese patients aged ≥4 years with FOS up to 12 months. More multicenter, real-world studies with large sample sizes and longer follow-ups are needed to further evaluate the long-term efficacy and safety of perampanel monotherapy.
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Affiliation(s)
- Haiyan Ma
- Department of Functional NeurosurgeryNanjing Brain Hospital affiliated to Nanjing Medical UniversityNanjingChina
| | - Haitao Zhu
- Department of Functional NeurosurgeryNanjing Brain Hospital affiliated to Nanjing Medical UniversityNanjingChina
| | - Fangqing Chen
- Department of Functional NeurosurgeryNanjing Brain Hospital affiliated to Nanjing Medical UniversityNanjingChina
| | - Yiqing Yang
- Department of Functional NeurosurgeryNanjing Brain Hospital affiliated to Nanjing Medical UniversityNanjingChina
| | - Xuefeng Qu
- Department of Functional NeurosurgeryNanjing Brain Hospital affiliated to Nanjing Medical UniversityNanjingChina
| | - Honghao Xu
- Department of Functional NeurosurgeryNanjing Brain Hospital affiliated to Nanjing Medical UniversityNanjingChina
| | - Lu Yang
- Department of Functional NeurosurgeryNanjing Brain Hospital affiliated to Nanjing Medical UniversityNanjingChina
| | - Rui Zhang
- Department of Functional NeurosurgeryNanjing Brain Hospital affiliated to Nanjing Medical UniversityNanjingChina
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10
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Gao L, Lu Q, Wang Z, Yue W, Wang G, Shao X, Guo Y, Yi Y, Hong Z, Jiang Y, Xiao B, Cui G, Gao F, Hu J, Liang J, Zhang M, Wang Y. Efficacy and safety of perampanel as early add-on therapy in Chinese patients with focal-onset seizures: a multicenter, open-label, single-arm study. Front Neurol 2023; 14:1236046. [PMID: 37712083 PMCID: PMC10499319 DOI: 10.3389/fneur.2023.1236046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/15/2023] [Indexed: 09/16/2023] Open
Abstract
Background No interventional study has been conducted in China to assess efficacy and safety of perampanel in treating Chinese patients with epilepsy, nor has there been any study on perampanel early add-on therapy in China. This interventional study aimed to assess efficacy and safety of perampanel as an early add-on treatment of focal-onset seizures (FOS) with or without focal-to-bilateral tonic-clonic seizures (FBTCS) in Chinese patients. Methods In this multicenter, open-label, single-arm, phase 4 interventional study, Chinese patients ≥ 12 years old with FOS with or without FBTCS who failed anti-seizure medication (ASM) monotherapy from 15 hospitals in China were enrolled and treated with perampanel add-on therapy (8-week titration followed by 24-week maintenance). The primary endpoint was 50% responder rate. Secondary endpoints included seizure-freedom rate and changes in seizure frequency from baseline. Treatment-emergent adverse events (TEAEs) and drug-related TEAEs were recorded. Results The full analysis set included 150 patients. The mean maintenance perampanel dose was 5.9 ± 1.5 mg/day and the 8-month retention rate was 72%. The 50% responder rate and seizure-freedom rate for all patients during maintenance were 67.9 and 30.5%, respectively. Patients with FBTCS had higher 50% responder rate (96.0%) and seizure-freedom rate (76.0%) during maintenance. Patients on concomitant sodium valproate had a significantly higher seizure-freedom rate than those on concomitant oxcarbazepine. Eight-six (55.1%) patients experienced treatment-related TEAEs, and the most common TEAEs were dizziness (36.5%), hypersomnia (11.5%), headache (3.9%), somnolence (3.2%), and irritability (3.2%). Withdrawal due to TEAEs occurred to 14.7% of the patients. Conclusion Perampanel early add-on was effective and safe in treating Chinese patients≥12 years old with FOS with or without FBTCS.Clinical trial registrationwww.chictr.org.cn, Identifier ChiCTR2000039510.
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Affiliation(s)
- Lehong Gao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qiang Lu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Zan Wang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Wei Yue
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Guoping Wang
- Division of Life Sciences and Medicine, Department of Neurology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Xiaoqiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi Guo
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Yonghong Yi
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Department of Neurology, Institute of Neuroscience, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhen Hong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuwu Jiang
- Department of Pediatrics and Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Guiyun Cui
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Feng Gao
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiasheng Hu
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianmin Liang
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, China
| | - Meiyun Zhang
- Department of Neurology, Tianjin Union Medical Center, Tianjin, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neuromodulation, Beijing, China
- Center of Epilepsy, Institute of Sleep and Consciousness Disorders, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- Neuromedical Technology Innovation Center of Hebei Province, Hebei Hospital of Xuanwu Hospital, Capital Medical University, Shijiazhuang, China
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11
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Perversi F, Costa C, Labate A, Lattanzi S, Liguori C, Maschio M, Meletti S, Nobili L, Operto FF, Romigi A, Russo E, Di Bonaventura C. The broad-spectrum activity of perampanel: state of the art and future perspective of AMPA antagonism beyond epilepsy. Front Neurol 2023; 14:1182304. [PMID: 37483446 PMCID: PMC10359664 DOI: 10.3389/fneur.2023.1182304] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/07/2023] [Indexed: 07/25/2023] Open
Abstract
Glutamate is the brain's main excitatory neurotransmitter. Glutamatergic neurons primarily compose basic neuronal networks, especially in the cortex. An imbalance of excitatory and inhibitory activities may result in epilepsy or other neurological and psychiatric conditions. Among glutamate receptors, AMPA receptors are the predominant mediator of glutamate-induced excitatory neurotransmission and dictate synaptic efficiency and plasticity by their numbers and/or properties. Therefore, they appear to be a major drug target for modulating several brain functions. Perampanel (PER) is a highly selective, noncompetitive AMPA antagonist approved in several countries worldwide for treating different types of seizures in various epileptic conditions. However, recent data show that PER can potentially address many other conditions within epilepsy and beyond. From this perspective, this review aims to examine the new preclinical and clinical studies-especially those produced from 2017 onwards-on AMPA antagonism and PER in conditions such as mesial temporal lobe epilepsy, idiopathic and genetic generalized epilepsy, brain tumor-related epilepsy, status epilepticus, rare epileptic syndromes, stroke, sleep, epilepsy-related migraine, cognitive impairment, autism, dementia, and other neurodegenerative diseases, as well as provide suggestions on future research agenda aimed at probing the possibility of treating these conditions with PER and/or other AMPA receptor antagonists.
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Affiliation(s)
| | - Cinzia Costa
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Neurological Clinic, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Angelo Labate
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome ‘Tor Vergata”, Rome, Italy
- Epilepsy Center, Neurology Unit, University Hospital “Tor Vergata”, Rome, Italy
| | - Marta Maschio
- Center for Tumor-Related Epilepsy, UOSD Neuro-Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Stefano Meletti
- Neurology Department, University Hospital of Modena, Modena, Italy
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
| | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genova, Genova, Italy
| | - Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
- Department of Science of Health, School of Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Andrea Romigi
- Sleep Medicine Center, Neurological Mediterranean Institute IRCCS Neuromed, Pozzilli, Italy
- Psychology Faculty, International Telematic University Uninettuno, Rome, Italy
| | - Emilio Russo
- Department of Science of Health, School of Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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12
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Park KI, Hwang S, Son H, Chu K, Jung KY, Lee SK. Five-Year Retention of Perampanel and Polytherapy Patterns: 328 Patients From a Single Center in South Korea. J Clin Neurol 2023; 19:358-364. [PMID: 37417431 DOI: 10.3988/jcn.2022.0338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Perampanel (PER) is an α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid antagonist used to treat focal and generalized epilepsy. Comprehensive data from real-world settings with long-term follow-ups are still scarce. This study aimed to determine the factors related to PER retention and the polytherapy pattern with PER. METHODS We reviewed all patients with epilepsy with a history of PER prescription during 2008-2017 and over a follow-up of >3 years. PER usage patterns and associated factors were analyzed. RESULTS Among the 2,655 patients in the cohort, 328 (150 females, 178 males) were enrolled. The ages at onset and diagnosis were 21.1±14.7 years and 25.6±16.1 years (mean±standard deviation), respectively. The age at the first visit to our center was 31.8±13.8 years. Seizure types were focal, generalized, and unknown onset in 83.8%, 15.9%, and 0.3% of patients, respectively. The most common etiology was structural (n=109, 33.2%). The maintenance duration of PER was 22.6±19.2 months (range=1-66 months). The initial number of concomitant antiseizure medications was 2.4±1.4 (range=0-9). The most common regimen was PER plus levetiracetam (n=41, 12.5%). The median number of 1-year seizures before PER usage was 8 (range=0-1,400). A seizure reduction of >50% was recorded in 34.7% of patients (52.0% and 29.2% in generalized and focal seizures, respectively). The 1-, 2-, 3-, 4-, and 5-year retention rates for PER were 65.3%, 50.4%, 40.4%, 35.3%, and 21.5%, respectively. A multivariate analysis indicated that lower age at onset was associated with longer retention (p=0.01). CONCLUSIONS PER was safely used in patients with diverse characteristics and was maintained for a long time in a real-world setting, especially in patients with a lower age at onset.
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Affiliation(s)
- Kyung-Il Park
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
- Division of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Sungeun Hwang
- Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Hyoshin Son
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Kon Chu
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Ki-Young Jung
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.
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13
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Lim SC, Lee WG, Kim DW, Kim KK, Shon YM, Park J, Lee Y, Seo DW. Safety and effectiveness of perampanel monotherapy after adjunctive therapy through retention rate in subjects with focal-onset seizures with or without focal to bilateral tonic-clonic seizures: A multicenter retrospective study in Korea. Epilepsy Behav 2023; 145:109291. [PMID: 37336136 DOI: 10.1016/j.yebeh.2023.109291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To assess the effectiveness and tolerability of perampanel monotherapy following conversion from adjunctive therapy. METHODS This was a multicenter, retrospective, non-interventional study of Korean patients aged ≥12 years with focal-onset seizures (FOS) with or without focal to bilateral tonic-clonic seizures. Data were extracted from electronic medical records of perampanel-treated patients from 1 February 2016 to 31 October 2020. Kaplan-Meier estimated retention rates, effectiveness, and safety were recorded. RESULTS Subjects (n = 66, mean age 46.2 years) were mostly male (68.2%) with focal to bilateral tonic-clonic seizure (71.2%). Mean duration of illness was 86.3 months. Retention rates after conversion to perampanel monotherapy at 3, 6, and 12 months (primary outcome) were 96.0%, 96.0%, and 75.6%, respectively. Overall retention rates in patients receiving perampanel as adjunctive or monotherapy at 3, 6, 12, 18, and 24 months after perampanel add-on were 100%, 98.3%, 95.9%, 92.6%, and 92.6%, respectively. Mean retention duration was 41.2 months (overall perampanel administration) and 21.4 months (monotherapy). Mean seizure frequency/28 days in the Full Analysis Set (n = 61) was comparable for adjunctive and monotherapy (0.2 ± 0.79 vs 0.2 ± 0.64; change between adjunctive and monotherapy periods: 0.0 ± 0.59; p = 0.498). Perampanel was well tolerated and no new safety signals were identified. Dizziness (4.6%), only reported during adjunctive therapy, was the most common treatment-emergent adverse event. CONCLUSIONS Conversion to perampanel monotherapy from adjunctive therapy showed promising results in subjects with FOS with/without focal to bilateral tonic-clonic seizures; further studies in a larger population are needed to confirm these encouraging data.
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Affiliation(s)
- Sung Chul Lim
- Department of Neurology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Won Gu Lee
- Department of Neurology, Kosin University Gospel Hospital, University of Kosin College of Medicine, Busan, Republic of Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kwang Ki Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Young-Min Shon
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Yoona Lee
- Eisai Korea Inc., Seoul, Republic of Korea
| | - Dae-Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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14
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Liguori C, Santamarina E, Strzelczyk A, Rodríguez-Uranga JJ, Shankar R, Rodríguez-Osorio X, Auvin S, Bonanni P, Trinka E, McMurray R, Sáinz-Fuertes R, Villanueva V. Perampanel outcomes at different stages of treatment in people with focal and generalized epilepsy treated in clinical practice: Evidence from the PERMIT study. Front Neurol 2023; 14:1120150. [PMID: 37064177 PMCID: PMC10098362 DOI: 10.3389/fneur.2023.1120150] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/13/2023] [Indexed: 04/03/2023] Open
Abstract
IntroductionThe PERMIT study is the largest pooled analysis of perampanel (PER) clinical practice data conducted to date.MethodsThis post-hoc analysis of PERMIT investigated the effectiveness, safety and tolerability of PER when used as early add-on therapy (after failure of one or two previous antiseizure medications) in comparison with late add-on therapy (after failure of three or more previous antiseizure medications). Retention and effectiveness were assessed after 3, 6, and 12 months, and at the last visit (last observation carried forward). Effectiveness was assessed by seizure type (total seizures, focal seizures, generalized tonic-clonic seizures [GTCS]) and assessments included seizure freedom rate and responder rate. Safety and tolerability were assessed by evaluating adverse events (AEs) and discontinuation due to AEs.ResultsThe Full Analysis Set included 1184 and 2861 PWE treated with PER as early and late add-on therapy, respectively. Compared to the late add-on subgroup, the early add-on subgroup was characterized by later mean age at epilepsy onset, shorter mean duration of epilepsy, lower rates of intellectual disability and psychiatric comorbidity, and lower frequency of seizures per month, suggesting a less severe form of epilepsy in this subgroup. After 12 months, retention was significantly higher in the early versus late add-on subgroup (67.7% vs. 62.4%; p = 0.004). At the last visit, responder rates in the early versus late add-on subgroup were significantly higher for total seizures (68.2% vs. 39.3%; p < 0.001), focal seizures (65.0% vs. 36.8%; p < 0.001) and GTCS (83.7% vs. 67.2%; p < 0.001), as were seizure freedom rates (total seizures, 35.9% vs. 11.9% [p < 0.001]; focal seizures, 29.4% vs. 8.7% [p < 0.001]; GTCS, 69.0% vs. 48.1% [p < 0.001]). Incidence of AEs was significantly lower in the early versus late add-on subgroup (42.1% vs. 54.7%; p < 0.001), as was the rate of discontinuation due to AEs over 12 months (15.0% vs. 18.1%; p = 0.031).DiscussionThis study demonstrated that PER was effective and generally well tolerated when initiated as early or late add-on therapy, but it was significantly more effective and better tolerated when initiated early. These findings support PER's use as a broad-spectrum, early add-on therapy for use in PWE with focal and generalized seizures.
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Affiliation(s)
- Claudio Liguori
- Epilepsy Centre, Neurology Unit, University Hospital “Tor Vergata”, Rome, Italy
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
- *Correspondence: Claudio Liguori
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University, Frankfurt am Main, Germany
| | | | - Rohit Shankar
- Peninsula School of Medicine, Plymouth, United Kingdom
| | - Xiana Rodríguez-Osorio
- Department of Neurology, Complexo Hospitalario Universitario de Santiago, Santiago, Spain
| | - Stéphane Auvin
- Université Paris Cité, INSERM NeuroDiderot, Paris, France
- APHP, Robert Debré University Hospital, Pediatric Neurology Department, CRMR Epilepsies Rares, EpiCare Member, Paris, France
- Institut Universitaire de France (IUF), Paris, France
| | - Paolo Bonanni
- Epilpesy and Clinical Neurophysiology Unit, Scientific Institute, IRCCS Eugenio Medea, Conegliano, Treviso, Italy
| | - Eugen Trinka
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Member of EpiCARE, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
- Institute of Public Health, Medical Decision-Making and HTA, UMIT–Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
| | | | | | - Vicente Villanueva
- Refractory Epilepsy Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Hou L, Yang J, Zhang X, Li N, Li S, Zhang L, Zhao J, Wang Q. Efficacy and tolerability of perampanel in patients with seizures in real-world clinical practice: A systematic review and meta-analysis. Front Pharmacol 2023; 14:1139514. [PMID: 37056989 PMCID: PMC10086234 DOI: 10.3389/fphar.2023.1139514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
Objectives: The aim of this study was to systematically review the efficacy and tolerability of perampanel (PER) when used as add-on treatment or monotherapy in patients with epilepsy aged 12 years and older in routine clinical practice.Methods: Electronic and clinical trials databases were searched for observational studies of PER published up to 1 March 2022. The outcomes of interest were responder rates, adverse effects (AEs), and withdrawal rates. Subgroup analyses were performed to explore the potential factors that might affect the efficacy and safety of PER usage.Results: A total of 56 studies, which included 10,688 patients, were enrolled. The results showed that after 3, 6, and 12 months of PER treatment, the pooled 50% responder rates in patients with epilepsy were 50.0% (95% CI: 0.41–0.60), 44.0% (95% CI: 0.38–0.50), and 39.0% (95% CI: 0.31–0.48), respectively, and the pooled seizure-free rates were 24.0% (95% CI: 0.17–0.32), 21.0% (95% CI: 0.17–0.25), and 20.0% (95% CI: 0.16–0.24), respectively. Subgroup analyses revealed that the efficacy of PER could be affected by the way in which PER is administrated. Patients in the groups where PER was used as the first add-on, primary monotherapy, or combined with non–enzyme-inducing AEDs (non-EIAEDs) displayed a high 50% responder rate and seizure-free rate when compared with those in the late add-on, conversion therapy, or combined with the EIAEDs groups, respectively. Furthermore, the incidences of AEs at 3, 6, and 12 months of PER treatment were 46% (95% CI: 0.38–0.55), 52.0% (95% CI: 0.43–0.60), and 46.0% (95% CI: 0.40–0.52), respectively. The withdrawal rates due to AEs were 8.0% (95% CI: 0.06–0.11), 16.0% (95% CI: 0.13–0.20), and 16% (95% CI: 0.11–0.21) at 3, 6, and 12 months of PER treatment, respectively. Subgroup analyses showed a higher withdrawal rate in the rapid (30%, 95% CI: 0.22–0.38) than in the slow (12%, 95% CI: 0.06–0.18) titration group.Conclusion: Altogether, PER was effective and could be fairly tolerated in both short-term and long-term usage in patients with epilepsy in routine clinical practice. Furthermore, PER appeared to be more effective when PER was used as the first add-on, monotherapy, or concomitant with non-EIAEDs.Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022384532.
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Affiliation(s)
- Liyan Hou
- Dalian Medical University Library, Dalian Medical University, Dalian, China
| | - Jingjing Yang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xuan Zhang
- National-Local Joint Engineering Research Center for Drug-Research and Development R & D of Neurodegenerative Diseases, Dalian Medical University, Dalian, China
| | - Na Li
- National-Local Joint Engineering Research Center for Drug-Research and Development R & D of Neurodegenerative Diseases, Dalian Medical University, Dalian, China
| | - Sheng Li
- National-Local Joint Engineering Research Center for Drug-Research and Development R & D of Neurodegenerative Diseases, Dalian Medical University, Dalian, China
| | - Lei Zhang
- Dalian Medical University Library, Dalian Medical University, Dalian, China
- *Correspondence: Lei Zhang, ; Jie Zhao, ; Qingshan Wang,
| | - Jie Zhao
- National-Local Joint Engineering Research Center for Drug-Research and Development R & D of Neurodegenerative Diseases, Dalian Medical University, Dalian, China
- *Correspondence: Lei Zhang, ; Jie Zhao, ; Qingshan Wang,
| | - Qingshan Wang
- National-Local Joint Engineering Research Center for Drug-Research and Development R & D of Neurodegenerative Diseases, Dalian Medical University, Dalian, China
- School of Public Health, Dalian Medical University, Dalian, China
- *Correspondence: Lei Zhang, ; Jie Zhao, ; Qingshan Wang,
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Gasparini S, Ferlazzo E, Neri S, Cianci V, Iudice A, Bisulli F, Bonanni P, Caggia E, D'Aniello A, Di Bonaventura C, DiFrancesco JC, Domina E, Dono F, Gambardella A, Marini C, Marrelli A, Matricardi S, Morano A, Paladin F, Renna R, Striano P, Pascarella A, Ascoli M, Aguglia U. Effectiveness of perampanel as the only add-on: Retrospective, multicenter, observational real-life study on epilepsy patients. Epilepsia Open 2022; 7:687-696. [PMID: 36082380 PMCID: PMC9712478 DOI: 10.1002/epi4.12649] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/31/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Perampanel (PER) is indicated as adjunctive antiseizure medication (ASM) in adolescents and adults with epilepsy. Data from clinical trials show good efficacy and tolerability, while limited information is available on the routine clinical use of PER, especially when used as only add-on treatment. METHODS We performed an observational, retrospective, multicenter study on people with focal or generalized epilepsy aged >12 years, consecutively recruited from 52 Italian epilepsy centers. All patients received PER as the only add-on treatment to a background ASM according to standard clinical practice. Retention rate, seizure frequency, and adverse events were recorded at 3, 6, and 12 months after PER introduction. Subanalyses by early or late use of PER and by concomitant ASM were also conducted. RESULTS Five hundred and three patients were included (age 36.5 ± 19.9 years). Eighty-one percent had focal epilepsy. Overall, the retention rate was very high in the whole group (89% at 12 months) according with efficacy measures. No major differences were observed in the subanalyses, although patients who used PER as early add-on, as compared with late add-on, more often reached early seizure freedom at 3-month follow-up (66% vs 53%, P = .05). Treatment-emergent adverse events occurred in 25%, far less commonly than in PER randomized trials. SIGNIFICANCE This study confirms the good efficacy and safety of PER for focal or generalized epilepsy in real-life conditions. We provide robust data about its effectiveness as only add-on treatment even in patients with a long-standing history of epilepsy and previously treated with many ASMs.
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Affiliation(s)
- Sara Gasparini
- Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
- Regional Epilepsy Centre, Great Metropolitan “Bianchi‐Melacrino‐Morelli Hospital”Reggio CalabriaItaly
| | - Edoardo Ferlazzo
- Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
- Regional Epilepsy Centre, Great Metropolitan “Bianchi‐Melacrino‐Morelli Hospital”Reggio CalabriaItaly
- Institute of Molecular Bioimaging and Physiology, National Research CouncilCatanzaroItaly
| | - Sabrina Neri
- Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
- Regional Epilepsy Centre, Great Metropolitan “Bianchi‐Melacrino‐Morelli Hospital”Reggio CalabriaItaly
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan “Bianchi‐Melacrino‐Morelli Hospital”Reggio CalabriaItaly
| | - Alfonso Iudice
- Department of Neurosciences, Section of NeurologyUniversity of PisaPisaItaly
| | - Francesca Bisulli
- Department of Biomedical and NeuroMotor SciencesAlma Mater Studiorum‐University of BolognaBolognaItaly
| | - Paolo Bonanni
- Epilepsy and Clinical Neurophysiology UnitScientific Institute, IRCCS Eugenio MedeaTrevisoItaly
| | | | | | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Human Neurosciences"Sapienza" University of RomeRomeItaly
| | - Jacopo C. DiFrancesco
- Department of Neurology, ASST S. Gerardo HospitalUniversity of Milano‐BicoccaMonzaItaly
| | | | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Science"G. D'Annunzio" University of Chieti‐PescaraChietiItaly
| | - Antonio Gambardella
- Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
- Institute of Molecular Bioimaging and Physiology, National Research CouncilCatanzaroItaly
- Neurologic ClinicMagna Græcia University of CatanzaroCatanzaroItaly
| | - Carla Marini
- Child Neurology and Psychiatric Unit, G. Salesi Pediatric HospitalUnited Hospitals of AnconaAnconaItaly
| | - Alfonso Marrelli
- Neurophysiopathology Unit, Epilepsy CenterSan Salvatore HospitalL'AquilaItaly
| | - Sara Matricardi
- Child Neurology and Psychiatric Unit, G. Salesi Pediatric HospitalUnited Hospitals of AnconaAnconaItaly
| | | | | | - Rosaria Renna
- Unit of Neurology, Multiple Sclerosis CenterRegina Elena National Cancer Institute, IFORomeItaly
| | - Pasquale Striano
- IRCCS Istituto Giannina GasliniGenovaItaly
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversity of GenovaGenoaItaly
| | - Angelo Pascarella
- Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
| | | | - Umberto Aguglia
- Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
- Regional Epilepsy Centre, Great Metropolitan “Bianchi‐Melacrino‐Morelli Hospital”Reggio CalabriaItaly
- Institute of Molecular Bioimaging and Physiology, National Research CouncilCatanzaroItaly
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Wheless J, Chourasia N. Safety evaluation of perampanel as monotherapy or first adjunctive therapy in patients with epilepsy. Expert Opin Drug Saf 2022; 21:1239-1247. [PMID: 36263757 DOI: 10.1080/14740338.2022.2134856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION There is a need for anti-seizure medications (ASMs) that are well tolerated and effective as monotherapy or first adjunctive therapy to reduce the need for adjunctive ASMs to treat newly diagnosed epilepsy, and to reduce the number of concomitant ASMs in patients with refractory epilepsy. Although the pivotal trials of perampanel evaluated its adjunctive use in patients with refractory seizures, open-label/real-world studies support its use in first/second-line settings. AREAS COVERED This paper reviews the pharmacology, efficacy, and safety/tolerability of perampanel, focusing on its use as monotherapy or first adjunctive therapy. The safety of perampanel in special populations and its safety/tolerability compared with that of other ASMs is also discussed. EXPERT OPINION Perampanel is a favorable candidate for initial or first adjunctive therapy due to its favorable efficacy and safety/tolerability as monotherapy and adjunctive therapy, its long half-life and ease of use, and its limited drug-drug interactions. The proposed mitigation strategies for managing the risk of serious psychiatric adverse events are appropriate patient selection, use of low doses, and slow titration. The growing body of evidence might shift current treatment strategies towards the early use of perampanel and its use at a low dose (4 mg/day).
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Affiliation(s)
- James Wheless
- University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Nitish Chourasia
- University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN, USA
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18
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Estévez-María JC, Garamendi-Ruiz I. The real-world effectiveness and safety of perampanel in Europe: A scoping review. Epilepsy Behav 2022; 134:108777. [PMID: 35816832 DOI: 10.1016/j.yebeh.2022.108777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/27/2022] [Accepted: 05/29/2022] [Indexed: 11/16/2022]
Abstract
In order to characterize the real-world effectiveness and safety of perampanel during clinical use in Europe, we conducted a structured literature search and scoping review of real-world studies conducted in Europe in adolescents (aged ≥ 12 years) or adults who were prescribed perampanel for focal epilepsy or primary generalized tonic-clonic seizures in the context of idiopathic generalized epilepsy, published between January 2016 and July 2021. We identified 29 relevant studies (20 retrospective and 9 prospective) in 3608 patients; median study duration was 12 months. Most patients (76.1%) were receiving two or more antiseizure drugs (ASDs) when perampanel was initiated. The maintenance perampanel dose ranged from 2 to 16 mg/day (most commonly 6 mg/day). Retention rate at 12 months ranged from 46% to 90.5% (median 71.1%). The proportion of patients who were free of seizures during perampanel ranged from 1.8% to 84.6%, but were consistently below 20% in studies where patients had received an average of ≥5 prior ASDs and above 20% where patients had received an average of <5 prior ASDs. The proportion of patients who achieved ≥50% reduction in seizures during perampanel ranged from 20.0% to 85.7%. Across all studies, the incidence of adverse events (AEs) ranged from 18.2% to 67.4% (median 37.1%) and discontinuation due to AEs from 6.2% to 56% (median 12.5%). Discontinuation rates tended to be higher in UK studies than in studies from Italy or Spain. The most commonly reported individual AEs were dizziness/vertigo (median incidence 13.7%), somnolence (median 11.9%), aggression (median 9.8%), irritability (median 9.1%), and cognitive deficits (median 7.0%). There was no relationship between the overall rate of AEs and perampanel dose, perampanel plasma levels, or number of concomitant medications. Our global overview of European observational studies with perampanel provides evidence that this agent is effective and safe in clinical practice in a range of countries, patients, and settings.
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19
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Fong YO, Huang P, Hsu CY, Yang YH. Effects of Perampanel on Seizure Control, Cognition, Behavior, and Psychological Status in Patients With Epilepsy: A Systematic Review. J Clin Neurol 2022; 18:653-662. [DOI: 10.3988/jcn.2022.18.6.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Yi-On Fong
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Poyin Huang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung Yao Hsu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- School of Post-Baccalaureate Medicine, Colleague of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Maguire M, Ben-Menachem E, Patten A, Malhotra M, Ngo LY. A post-approval observational study to evaluate the safety and tolerability of perampanel as an add-on therapy in adolescent, adult, and elderly patients with epilepsy. Epilepsy Behav 2022; 126:108483. [PMID: 34953337 DOI: 10.1016/j.yebeh.2021.108483] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/11/2021] [Accepted: 11/28/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Perampanel is a once-daily oral anti-seizure medication for focal-onset seizures, with or without focal to bilateral tonic-clonic seizures (FBTCS), and generalized tonic-clonic seizures. Study 402 (NCT02033902) collected safety information on clinically important treatment-emergent adverse events (TEAEs) from real-world clinical practice in patients aged ≥12 years with refractory epilepsy who were receiving perampanel as an add-on therapy. METHODS Study 402 was a multicenter, observational, 52-week cohort study conducted in Austria, Belgium, Czech Republic, Denmark, France, Israel, Sweden, and the United Kingdom. Safety data were gathered prospectively from patients at clinic visits. The primary endpoint was the incidence of clinically important TEAEs defined as dizziness; blurred vision; somnolence; aggression; balance disorders (including ataxia and falls); weight gain; suicidality; drug abuse, misuse, dependence, and withdrawal; skin photosensitivity; and unintended pregnancy while taking levonorgestrel-containing contraceptives. Off-label use of perampanel and outcomes associated with any suspected drug-drug interaction were also monitored and recorded. Secondary endpoints included the Hospital Anxiety and Depression Scale (HADS) and Clinical Global Impression of Change. RESULTS Of 483 patients in the Safety Analysis Set, mean (standard deviation [SD]) age was 38.3 (15.1) years, 48.4% were female, mean (SD) time since diagnosis was 23 (14.8) years, 56.5% had focal impaired awareness seizures, and 48.7% had FBTCS. Overall, 243 (49.3%) patients treated with perampanel completed the study and 227 (46.0%) patients discontinued. The most common primary reason for discontinuation was adverse events (n = 130 [26.4%]). A total of 301 (62.3%) patients reported at least one TEAE, of which 45 (15.0%) patients had severe TEAEs and 256 (85.0%) patients had TEAEs judged as mild to moderate in severity. Overall, 51 (10.6%) patients had serious TEAEs, including two deaths that were judged as not related to perampanel, and 136 (28.2%) patients experienced a TEAE that led to treatment discontinuation. Clinically important TEAEs were reported by 153 (31.7%) patients, with the most common being dizziness (13.9%), balance disorders (5.6%), aggression (5.4%), and weight gain (5.4%). In general, the frequencies of clinically important TEAEs were lower in this study compared with previous interventional clinical studies, except for the incidence of suicidality (2.1% vs 1.0%) and aggression (5.4% vs 5.1%). Mean total HADS scores were similar at the end of the study compared with baseline; at the end of treatment, most (>60%) patients had no shift in HADS score category; ∼15% of patients moved to a worse category vs baseline and ∼20% of patients moved to an improved category vs baseline for both anxiety and depression. Based on investigator assessment, disease severity was improved in 185/415 (44.6%) patients. A subanalysis in elderly patients aged ≥65 years showed similar results to the overall population. CONCLUSIONS The data from this observational study are consistent with the known safety profile of perampanel derived from previous interventional phase II and III clinical studies. No unusual or unexpected TEAEs were observed in this real-world clinical practice setting.
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Affiliation(s)
- Melissa Maguire
- Leeds General Infirmary, Great George Street, Leeds, West Yorkshire LS1 3EX, UK.
| | - Elinor Ben-Menachem
- Sahlgrenska Academy, University of Gothenburg, Blå Stråket 7, Plan 0, 41345 Gothenburg, Sweden.
| | - Anna Patten
- Eisai Europe Ltd., EMEA Knowledge Centre, Mosquito Way, Hatfield, Hertfordshire AL10 9SN, UK.
| | - Manoj Malhotra
- Eisai Global Neurology Business Unit, 100 Tice Boulevard, Woodcliff Lake, NJ 07677, USA.
| | - Leock Y Ngo
- Eisai Global Neurology Business Unit, 100 Tice Boulevard, Woodcliff Lake, NJ 07677, USA.
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Lim GY, Chen CL, Chan Wei Shih D. Utility and Safety of Perampanel in Pediatric FIRES and Other Drug-Resistant Epilepsies. Child Neurol Open 2021; 8:2329048X211055335. [PMID: 34820471 PMCID: PMC8606971 DOI: 10.1177/2329048x211055335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/17/2021] [Accepted: 10/01/2021] [Indexed: 11/15/2022] Open
Abstract
Perampanel is a novel antiepileptic drug, which antagonises AMPA (alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid) glutamate receptor. We describe perampanel as an adjunctive treatment for FIRES (febrile infection-related epilepsy syndrome) and other drug-resistant epilepsies. A single-centre, observational, retrospective study involving 20 pediatric patients was conducted. Perampanel was started for three patients with FIRES, achieving seizure cessation in two patients within a day and on days 19 and 32 of illness. Doses used ranged from 4 to 12 mg/day, without any adverse effects reported or discontinuation of therapy. Responder-rate for other drug-resistant epilepsies is 25%. Median time to achieve ≥50% seizure reduction was 80 days (range: 26-326 days). Adverse effect reported in 47% of the patients includes central nervous system-related, and thrombocytopenia. Eight patients discontinued perampanel, because of ineffectiveness or adverse effects. The median time on perampanel before discontinuation was 179 days (range: 94-345 days). Perampanel may be of benefit in pediatrics FIRES and is of utility in other drug-resistant epilepsies.
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Affiliation(s)
- Guo Yong Lim
- Department of Pharmacy, KK Women's and Children's Hospital, Singapore, Singapore
| | - Chun Liang Chen
- Department of Pharmacy, KK Women's and Children's Hospital, Singapore, Singapore
| | - Derrick Chan Wei Shih
- Department of Pediatric Medicine, Neurology Service, KK Women's and Children's Hospital, Singapore
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Chinvarun Y. A retrospective, real-world experience of perampanel monotherapy in patient with first new onset focal seizure: A Thailand experience. Epilepsia Open 2021; 7:67-74. [PMID: 34741590 PMCID: PMC8886062 DOI: 10.1002/epi4.12555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/13/2021] [Accepted: 10/26/2021] [Indexed: 11/08/2022] Open
Abstract
Objective Real‐world data on efficacy and tolerability of perampanel (PER) monotherapy in treatment‐naïve patients with focal onset seizures (FOS) and/or focal‐to‐bilateral tonic‐clonic seizures (FBTCS) to assess efficacy effectiveness and tolerability. Methods This is a retrospective review of study patients with new FOS with or without FBTCS, aged ≥15 years, who had been prescribed PER as monotherapy. Treatment outcome included retention rate, responder, and seizure‐free rate at observational point 3, 6, and 12 months (OP3, OP6, and OP12). Treatment‐emergent adverse events (TEAEs) and adverse drug reactions were recorded. Results A total of 41 patients enrolled in the study (male:female; 17:22, mean age =46.1 ± 21.8 years), with new FOS and/or FBTCS. The proportions of individuals remaining on PER monotherapy at 3, 6, and 12 months were evaluated. The median PER dosage was 4 mg (range 2‐8 mg). The retention rates at OP3, OP6, and OP12 were 88%, 73%, and 61%, respectively. The seizure freedom rates at OP3, OP6, and OP12 were 78%, 80%, and 76%, respectively. About 14% had discontinued the PER monotherapy because of lack of efficacy. Sixteen individuals (41%) had TEAEs; common AEs were dizziness, somnolence, and ataxia; and only one case had depression. The AEs with somnolence and ataxia were found higher in elderly (15% and 30%) than adult patients (7% and 3%), respectively. Only 14% had intolerant adverse events, and it was found higher in elderly (23%). Significance Real‐world data of PER monotherapy in treatment‐naïve patients with focal onset seizures demonstrated good effectiveness and a good safety profile at relatively low doses. By starting with low dosage and slow titration of PER help to minimize the impact of adverse effects, maximize adherence, and increase patient retention. PER has a once‐daily dosing schedule that supports patient adherence contributes to achieving seizure freedom.
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Affiliation(s)
- Yotin Chinvarun
- Department of Neurology, Phramongkutklao Royal Army Hospital and Medical College, Bangkok, Thailand
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23
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Bonanni P, Gambardella A, Tinuper P, Acone B, Perucca E, Coppola G. Perampanel as first add-on antiseizure medication: Italian consensus clinical practice statements. BMC Neurol 2021; 21:410. [PMID: 34702211 PMCID: PMC8549193 DOI: 10.1186/s12883-021-02450-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/14/2021] [Indexed: 01/21/2023] Open
Abstract
Background When use of a single antiseizure medication (ASM) fails to induce seizure remission, add-on therapy is justified. Perampanel (PER) is approved in Europe as adjunctive therapy for focal, focal to bilateral tonic-clonic seizures and generalized tonic-clonic seizures. Aim of the study was to establish whether PER is suitable for first add-on use. Methods A Delphi methodology was adopted to assess consensus on a list of 39 statements produced by an Expert Board of 5 epileptologists. Using an iterative process, statements were finalized by a Delphi Panel of 84 Italian pediatric and adult neurologists. Each statement was rated anonymously to determine level of agreement on a 9-point Likert scale. Consensus was established as agreement by at least 80% of the panelists. The relevance of each statement was also assessed on a 3-point scale. Results Consensus was achieved for 37 statements. Characteristics of PER considered to justify its use as first add-on include evidence of a positive impact on quality of life based on long term retention data, efficacy, tolerability, and ease of use; no worsening of cognitive functions and sleep quality; a low potential for drug interactions; a unique mechanism of action. Potential unfavorable factors are the need for a relatively slow dose titration; the potential occurrence of behavioral adverse effects; lack of information on safety when used in pregnancy; limited access to plasma PER levels. Conclusion Perampanel has many features which justify its use as a first add-on. Choice of an ASM as first add-on should be tailored to individual characteristics. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02450-y.
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Affiliation(s)
- Paolo Bonanni
- IRCCS Eugenio Medea Scientific Institute, Epilepsy Unit, Conegliano, Via Costa Alta 37, 31015, Conegliano, TV, Italy.
| | | | - Paolo Tinuper
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Emilio Perucca
- Division of Clinical and Experimental Pharmacology, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.,Department of Neuroscience, Monash University, Melbourne, Australia
| | - Giangennaro Coppola
- Department of Medicine, Surgery, Odontoiatry, Medical School of Salerno, University of Salerno, Salerno, Italy
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PERMIT study: a global pooled analysis study of the effectiveness and tolerability of perampanel in routine clinical practice. J Neurol 2021; 269:1957-1977. [PMID: 34427754 PMCID: PMC8940799 DOI: 10.1007/s00415-021-10751-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 12/22/2022]
Abstract
The PERaMpanel pooled analysIs of effecTiveness and tolerability (PERMIT) study was a pooled analysis of data from 44 real-world studies from 17 countries, in which people with epilepsy (PWE; focal and generalized) were treated with perampanel (PER). Retention and effectiveness were assessed after 3, 6, and 12 months, and at the last visit (last observation carried forward). Effectiveness assessments included 50% responder rate (≥ 50% reduction in seizure frequency from baseline) and seizure freedom rate (no seizures since at least the prior visit); in PWE with status epilepticus, response was defined as seizures under control. Safety and tolerability were assessed by evaluating adverse events (AEs) and discontinuation due to AEs. The Full Analysis Set included 5193 PWE. Retention, effectiveness and safety/tolerability were assessed in 4721, 4392 and 4617, respectively. Retention on PER treatment at 3, 6, and 12 months was 90.5%, 79.8%, and 64.2%, respectively. Mean retention time on PER treatment was 10.8 months. The 50% responder rate was 58.3% at 12 months and 50.0% at the last visit, and the corresponding seizure freedom rates were 23.2% and 20.5%, respectively; 52.7% of PWE with status epilepticus responded to PER treatment. Overall, 49.9% of PWE reported AEs and the most frequently reported AEs (≥ 5% of PWE) were dizziness/vertigo (15.2%), somnolence (10.6%), irritability (8.4%), and behavioral disorders (5.4%). At 12 months, 17.6% of PWEs had discontinued due to AEs. PERMIT demonstrated that PER is effective and generally well tolerated when used to treat people with focal and/or generalized epilepsy in everyday clinical practice.
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Chinvarun Y, Huang CW, Wu Y, Lee HF, Likasitwattanakul S, Ding J, Yamamoto T. Optimal Use of Perampanel in Asian Patients with Epilepsy: Expert Opinion. Ther Clin Risk Manag 2021; 17:739-746. [PMID: 34321883 PMCID: PMC8312314 DOI: 10.2147/tcrm.s316476] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/04/2021] [Indexed: 11/29/2022] Open
Abstract
Perampanel is a once-daily, first-in-class AMPA receptor antagonist approved for the treatment of epilepsy and exhibits broad-spectrum efficacy in a range of seizure types when used as both monotherapy and adjunctive therapy. Clinical studies and real-world evidence have demonstrated the advantages of initiating perampanel at low doses and utilizing a slow titration strategy. Initiating perampanel at an early stage has also been shown to be associated with better patient outcomes. However, the optimal use and place of perampanel in clinical practice has not yet been clearly defined for the Asian patient population. Use of perampanel in clinical practice varies markedly across the Asia region because of variation in knowledge, attitudes, and practice. There is currently no specific guidance on best practices for prescribing perampanel in Asian patients or how to optimize treatment strategies to maximize adherence. A group of epilepsy experts attended a virtual meeting in September 2020 to discuss their experience with using perampanel in the Asian practice setting, including their views regarding appropriate patient populations, optimal starting and maintenance doses, optimal titration regimens, key barriers to adherence, and prevention and management of adverse events. This article summarizes key clinical and real-world evidence for perampanel and consolidates the experts’ opinions on optimization of perampanel prescribing and adherence in real-world practice, providing practical strategies for clinicians to implement to improve outcomes for people with epilepsy in Asia.
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Affiliation(s)
- Yotin Chinvarun
- Department of Neurology, Phramongkutklao Royal Army Hospital and Medical College, Bangkok, Thailand
| | - Chin-Wei Huang
- Department of Neurology, National Cheng Kung University Hospital College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ye Wu
- Department of Pediatrics, Peking University First Hospital, Beijing, People's Republic of China
| | - Hsiu-Fen Lee
- Division of Pediatric Neurology, Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Surachai Likasitwattanakul
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jing Ding
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Takamichi Yamamoto
- Department of Neurosurgery, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
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Wang T, Wen B, Chi Z, Zhao X. The well responsiveness of drug-resistant focal seizures in anti-AMPA2 receptor encephalitis to perampanel treatment. Neurol Sci 2021; 43:525-532. [PMID: 33982144 DOI: 10.1007/s10072-021-05306-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 05/05/2021] [Indexed: 12/01/2022]
Abstract
Anti-α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor encephalitis is an anti-neuronal surface antigen autoimmune encephalitis and is relatively rare. Our study evaluated a patient who developed anti-AMPA2 receptor encephalitis with memory deficits and refractory focal seizures as paroxysmal jerking on right face as well as dystonic seizure on right hand. On this patient, the combination treatment of levetiracetam, carbamazepine, and clonazepam, monthly periodic intravenous immunoglobin and immunosuppressive therapies for 5 months was not effective for the focal seizures, while his memory loss was slightly improved. However, adjunctive perampanel treatment led to a rapid relief of seizures. Perampanel is suggested in seizures associated with anti-AMPA receptor encephalitis by directly attenuating nerve hyperexcitability caused by glutamate and Ca2+-permeable GluA4 subunit of AMPA receptors.
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Affiliation(s)
- Tan Wang
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Bing Wen
- Department of Neurology, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China.,Research Institute of Neuromuscular and Neurodegenerative Diseases, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Zhaofu Chi
- Department of Neurology, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Xiuhe Zhao
- Department of Neurology, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China.
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Canas N, Félix C, Silva V, Arraiolos A, Fernandez-Llimos F. Comparative 12-month retention rate, effectiveness and tolerability of perampanel when used as a first add-on or a late add-on treatment in patients with focal epilepsies: The COM-PER study. Seizure 2021; 86:109-115. [PMID: 33592505 DOI: 10.1016/j.seizure.2021.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/26/2021] [Accepted: 01/31/2021] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To compare the 12-month retention rate, effectiveness and tolerability of perampanel (PER) as a first or late add-on treatment in adult patients with focal-onset seizures (FOS), including focal to bilateral tonic-clonic seizures (FBTCS). METHODS This retrospective, observational, multicenter study was carried out in patients with FOS that received PER as a late add-on (n = 60), after failure of > 3 AEDs, and a group that received PER as a first add-on treatment (n = 21). RESULTS At 12 months, the retention (90.5 % vs. 48.3 %; p = 0.001), seizure-freedom (71.4 % vs. 13.3 %; p < 0.001) and responder (85.7 % vs. 28.3 %; p < 0.001) rates were significantly higher in the first add-on group compared with the late add-on group. In patients with FBTCS, the 12-month retention rate did not differ significantly between the first and late add-on groups (93.8 % vs. 66.7 %); however, seizure-freedom (81.2 % vs. 27.8 %; p = 0.002) and responder rate response (93.8 % vs. 44.4 %; p = 0.002) were significantly higher in the first add-on group. There were no significant differences in tolerability between the two groups, including in patients with FBTCS. Adverse events were reported in 54.3 % of patients (44/81), most were mild or moderate, with dizziness being the most frequent one. CONCLUSION Overall, retention rate and effectiveness at 12 months were significantly higher in patients taking PER as a first add-on than as a late add-on, and the tolerability of PER did not differ significantly between groups. PER demonstrated high effectiveness in patients with FBTCS, even as a late add-on treatment.
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Affiliation(s)
- Nuno Canas
- Hospital Beatriz Ângelo, Neurology Department, Loures, Portugal; Centro Hospitalar Lisboa Ocidental, Reference Center for Refractory Epilepsies, Neurology Department, Hospital Egas Moniz, Lisbon, Portugal; Hospital CUF Descobertas, Neurology Department, Lisbon, Portugal.
| | - Catarina Félix
- Centro Hospitalar e Universitário do Algarve, Neurology Department, Faro, Portugal
| | - Vanessa Silva
- Hospital Beatriz Ângelo, Neurology Department, Loures, Portugal
| | - Ana Arraiolos
- Hospital Beatriz Ângelo, Neurology Department, Loures, Portugal
| | - Fernando Fernandez-Llimos
- Laboratory of Pharmacology, Department of Drug Sciences, College of Pharmacy, University of Porto, Porto, Portugal
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Perampanel effectiveness and safety as early add-on treatment for focal-onset seizures: PEREAGAL study. Epilepsy Res 2021; 172:106570. [PMID: 33621770 DOI: 10.1016/j.eplepsyres.2021.106570] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Perampanel (PER) is an effective adjunctive therapy for controlling focal-onset seizures (FOS), but few studies have examined its effects as an early add-on for the treatment of FOS in daily clinical practice. METHODS Our retrospective, multicenter, observational study evaluated the effectiveness and safety of PER as an early add-on in 77 patients with FOS, with and without focal to bilateral tonic-clonic seizures (FBTCS) after 3, 6 and 12 months in a real-world setting. RESULTS After 12 months of treatment (median dose 6 [4,8] mg/day), the retention rate was 79.2 % and 60 % of patients (39/65) experienced a ≥50 % reduction in seizure frequency relative to baseline. The seizure-free rate was 38.5 % for all seizures (25/65) and 60 % for FBTCS (12/20). The responder rate at 12 months was significantly higher when PER was given with one concomitant AED (72.2 %) compared to when PER was given with two concomitant AEDs (44.8 %). Drug-related adverse events (AEs) were reported in 40.3 % of patients, most of them being mild (64.2 %). Twelve patients (15.6 %) discontinued treatment because of AEs. CONCLUSIONS PER is an effective and safe early add-on for patients with refractory FOS, especially for those with FBTCS.
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Labate A, Fortunato F, Giugno A, Martino I, Caligiuri ME, Gambardella A. Perampanel as first add-on choice on the treatment of mesial temporal lobe epilepsy: an observational real-life study. Neurol Sci 2020; 42:1389-1394. [DOI: 10.1007/s10072-020-04636-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/01/2020] [Indexed: 11/28/2022]
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Vlasov PN, Karlov VA, Zhidkova IA, Dmitrenko DV, Rudakova IG, Danilova TV, Kalinin VA, Grebenyuk OV, Gertsen AP, Zhuravlev YS, Karas AY, Paramonova EN, Ponomareva IV, Miguskina OI, Sobyanina NA, Sukhova DV, Salomatin YV, Ertakhova ML, Goguadze TM, Shamray AP. A Russian retrospective multicenter open-label observational study based on medical documentation on the use of perampanel in everyday clinical practice. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2020. [DOI: 10.14412/2074-2711-2020-3-47-55] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- P. N. Vlasov
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia
| | - V. A. Karlov
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia
| | - I. A. Zhidkova
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia
| | - D. V. Dmitrenko
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia
| | - I. G. Rudakova
- M.F. Vladimirsky Moscow Regional Clinical Research Institute
| | - T. V. Danilova
- Kazan State Medical University, Ministry of Health of Russia
| | - V. A. Kalinin
- Samara State Medical University, Ministry of Health of Russia
| | - O. V. Grebenyuk
- Siberian State Medical University, Ministry of Health of Russia
| | | | | | | | | | | | | | | | | | - Yu. V. Salomatin
- Z.P. Solovyev Research and Practical Psychoneurology Center, Moscow Healthcare Department
| | - M. L. Ertakhova
- Republican Children's Clinical Hospital, Ministry of Health of the Udmurt Republic
| | | | - A. P. Shamray
- Yu.K. Erdman Altai Territorial Clinical Mental Hospital
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Toledano Delgado R, García-Morales I, Parejo-Carbonell B, Jiménez-Huete A, Herrera-Ramirez D, González-Hernández A, Ayuga Loro F, Santamarina E, Toledo M, Ojeda J, Poza JJ, Molins A, Giner P, Estévez María JC, Castro-Vilanova MD, Zurita J, Saiz-Diaz RA, Gómez-Ibañez A, Rodriguez-Uranga J, Gil-Nagel A, Campos D, Sánchez-Larsen Á, Aguilar-Amat Prior MJ, Mauri Llerda JA, Huertas González N, García-Barragán N. Effectiveness and safety of perampanel monotherapy for focal and generalized tonic-clonic seizures: Experience from a national multicenter registry. Epilepsia 2020; 61:1109-1119. [PMID: 32511754 DOI: 10.1111/epi.16548] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To assess the effectiveness and tolerability of perampanel (PER) monotherapy in routine clinical practice for the treatment of focal onset and generalized tonic-clonic seizures (GTCS). METHODS This multicenter, retrospective, observational study was conducted in patients aged ≥12 years treated with PER as primary monotherapy or converted to PER monotherapy by progressive reduction of background antiepileptic drugs. Outcomes included retention, responder, and seizure-free rate after 3, 6, and 12 months and tolerability throughout the follow-up. RESULTS A total of 98 patients (mean age = 49.6 ± 21.7 years, 51% female) with focal seizures and/or GTCS were treated with PER monotherapy for a median exposure of 14 months (range = 1-57) with a median dose of 4 mg (range = 2-10). The retention rates at 3, 6, and 12 months and last follow-up were 93.8%, 89.3%, 80.9%, and 71.4%, respectively. The retention rates according to the type of monotherapy (primary vs conversion) did not differ (log-rank P value = .57). Among the 98 patients, 61.2% patients had seizures throughout the baseline period, with a median seizure frequency of 0.6 seizures per month (range = 0.3-26). Responder rates at 3, 6, and 12 months were 79.6%, 70.1%, and 52.8%, respectively, and seizure freedom rates at the same points were 62.7%, 56.1%, and 41.5%. Regarding the 33 patients who had GTCS in the baseline period, 87.8% were seizure-free at 3 months, 78.1% at 6 months, and 55.1% at 12 months. Over the entire follow-up, PER monotherapy was generally well tolerated, and only 16% of patients discontinued PER due to adverse events (AEs). Female patients were found to be at a higher risk of psychiatric AEs (female vs male odds ratio = 2.85, 95% confidence interval = 1-8.33, P = .046). SIGNIFICANCE PER demonstrated good effectiveness and a good safety profile when used as primary therapy or conversion to monotherapy at relatively low doses, in a clinical setting with patients with focal seizures and GTCS.
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Affiliation(s)
- Rafael Toledano Delgado
- Epilepsy Unit, Neurology Department, Hospital Ramón y Cajal, Madrid, Spain.,Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - Irene García-Morales
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain.,Epilepsy Unit, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | | | | | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Hospital Vall d´Hebron, Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Hospital Vall d´Hebron, Barcelona, Spain
| | - Joaquín Ojeda
- Neurology Department, Hospital Infanta Sofía, Madrid, Spain
| | - Juan José Poza
- Neurology Department, Hospital Donostia, San Sebastian, Spain
| | - Albert Molins
- Neurology Department, Hospital Josep Trueta, Girona, Spain
| | - Pau Giner
- Neurology Department, Hospital Dr. Peset, Valencia, Spain
| | | | | | - Jorge Zurita
- Neurology Department, Hospital Infanta Leonor, Madrid, Spain
| | | | | | | | - Antonio Gil-Nagel
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - Dulce Campos
- Neurology Department, Hospital Clínico de Valladolid, Valladolid, Spain
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