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Qayyum A, Zamir A, Rasool MF, Imran I, Ahmad T, Alqahtani F. Investigating clinical pharmacokinetics of brivaracetam by using a pharmacokinetic modeling approach. Sci Rep 2024; 14:13357. [PMID: 38858493 PMCID: PMC11164859 DOI: 10.1038/s41598-024-63903-1] [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: 11/18/2023] [Accepted: 06/03/2024] [Indexed: 06/12/2024] Open
Abstract
The development of technology and the processing speed of computing machines have facilitated the evaluation of advanced pharmacokinetic (PK) models, making modeling processes simple and faster. The present model aims to analyze the PK of brivaracetam (BRV) in healthy and diseased populations. A comprehensive literature review was conducted to incorporate the BRV plasma concentration data and its input parameters into PK-Sim software, leading to the creation of intravenous (IV) and oral models for both populations. The developed physiologically based pharmacokinetic (PBPK) model of BRV was then assessed using the visual predictive checks, mean observed/predicted ratios (Robs/pre), and average fold error for PK parameters including the maximum systemic concentration (Cmax), the area under the curve at time 0 to t (AUC0-∞), and drug clearance (CL). The PBPK model of BRV demonstrated that mean Robs/pre ratios of the PK parameters remained within the acceptable limits when assessed against a twofold error margin. Furthermore, model predictions were carried out to assess how AUC0-∞ is affected following the administration of BRV in individuals with varying degrees of liver cirrhosis, ranging from different child-pugh (CP) scores like A, B, and C. Moreover, dose adjustments were recommended by considering the variations in Cmax and CL in various kidney disease stages (mild to severe).
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Affiliation(s)
- Attia Qayyum
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Ammara Zamir
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan.
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Tanveer Ahmad
- Instiitute for Advanced Biosciences (IAB), CNRS UMR5309, INSERM U1209, Grenoble Alpes University, 38700, La Tronche, France
| | - Faleh Alqahtani
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, 11451, Riyadh, Saudi Arabia.
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Lattanzi S, Canafoglia L, Canevini MP, Casciato S, Cerulli Irelli E, Chiesa V, Dainese F, De Maria G, Didato G, Di Gennaro G, Falcicchio G, Fanella M, Ferlazzo E, Gangitano M, La Neve A, Mecarelli O, Montalenti E, Morano A, Piazza F, Pizzanelli C, Pulitano P, Ranzato F, Rosati E, Tassi L, Di Bonaventura C. Adjunctive brivaracetam and sustained seizure frequency reduction in very active focal epilepsy. Epilepsia 2023; 64:2922-2933. [PMID: 38079181 DOI: 10.1111/epi.17740] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE This study aimed to explore the effectiveness of brivaracetam (BRV) according to baseline seizure frequency and past treatment history in subjects with focal epilepsy who were included in the Brivaracetam Add-On First Italian Network Study (BRIVAFIRST). METHODS BRIVAFIRST was a 12-month retrospective, multicenter study including adults prescribed adjunctive BRV. Study outcomes included sustained seizure response (SSR), sustained seizure freedom (SSF), and the rates of treatment discontinuation and adverse events (AEs). Baseline seizure frequency was stratified as <5, 5-20, and >20 seizures per month, and the number of prior antiseizure medications (ASMs) as <5 and ≥6. RESULTS A total of 994 participants were included. During the 1-year study period, SSR was reached by 45.8%, 39.3%, and 22.6% of subjects with a baseline frequency of <5, 5-20, and >20 seizures per month (p < .001); the corresponding figures for the SSF were 23.4%, 9.8%, and 2.8% (p < .001). SSR was reached by 51.2% and 26.5% participants with a history of 1-5 and ≥6 ASMs (p < .001); the corresponding rates of SSF were 24.7% and 4.5% (p < .001). Treatment discontinuation due to lack of efficacy was more common in participants with >20 seizures compared to those with <5 seizures per month (25.8% vs. 9.3%, p < .001), and in participants with history of ≥6 prior ASMs compared to those with history of 1-5 ASMs (19.6% vs. 12.2%, p = .002). There were no differences in the rates of BRV withdrawal due to AEs and the rates of AEs across the groups of participants defined according to the number of seizures at baseline and the number of prior ASMs. SIGNIFICANCE The baseline seizure frequency and the number of previous ASMs were predictors of sustained seizure frequency reduction with adjunctive BRV in subjects with focal epilepsy.
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Affiliation(s)
- Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Laura Canafoglia
- Department of Epileptology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Paola Canevini
- Epilepsy Center, Child Neuropsychiatry Unit, AAST Santi Paolo Carlo, Milan, Italy
- Department of Health Sciences, Università degli Studi, Milan, Italy
| | | | - Emanuele Cerulli Irelli
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Valentina Chiesa
- Epilepsy Center, Child Neuropsychiatry Unit, AAST Santi Paolo Carlo, Milan, Italy
| | | | - Giovanni De Maria
- Clinical Neurophysiology Unit, Epilepsy Center, Spedali Civili, Brescia, Italy
| | - Giuseppe Didato
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Giovanni Falcicchio
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University Hospital of Bari A. Moro, Bari, Italy
| | - Martina Fanella
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Massimo Gangitano
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Angela La Neve
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University Hospital of Bari A. Moro, Bari, Italy
| | - Oriano Mecarelli
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Elisa Montalenti
- Epilepsy Center, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alessandra Morano
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Federico Piazza
- Rita Levi Montalcini Department of Neurosciences, University of Turin, Turin, Italy
| | - Chiara Pizzanelli
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Neurology Unit, Pisa University Hospital, Pisa, Italy
| | - Patrizia Pulitano
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Eleonora Rosati
- Department of Neurofarba, University of Florence, Florence, Italy
| | - Laura Tassi
- C. Munari Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Naddell S, Manuel M, Cavill R, White P, Sieradzan K. BRIVEST: A 'real-world' observational, single-centre study investigating the efficacy, safety and tolerability of Brivaracetam. Epilepsy Behav 2023; 138:108985. [PMID: 36442261 DOI: 10.1016/j.yebeh.2022.108985] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/07/2022] [Accepted: 10/29/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Via measures of efficacy, tolerability, and safety, this open-label, single-center study assessed the overall effectiveness of Brivaracetam (BRV) for the treatment of epilepsy in the context of 'real-world' clinical practice. METHODS Unselected consecutive patients were recruited and stratified into 3 cohorts with either fully prospective, fully retrospective or mixed data collection, dependent on whether their BRV prescriptions were historical, current, or pending. Prospective data were obtained at baseline, 3 and 6 months, and at 6-month intervals thereafter, from patient interviews and seizure diaries, and retrospective data from medical records. Efficacy variables were derived from seizure-related changes, and tolerability and safety variables from reported treatment-emergent adverse events (TEAEs), BRV withdrawal, and changes to questionnaire scores. Additionally, we investigated treatment outcomes for those with previous levetiracetam (LEV) use, a history of psychiatric comorbidity, a learning disability, and of older age. RESULTS One hundred and nine patients (58.7% female, mean age 42 years, range: 18 to 72) were included, 59 with prospective follow-up for a minimum of 6 (47 patients, excluding those who withdrew) and a maximum of 24 months (2 patients). Of the full cohort, 87.2% had drug-resistant epilepsy. Retention: At the study end, the median treatment duration was 384 days (range: 6 to 1514 days), and BRV retention was 68.8%. Kaplan-Meier survival functions predicted retention rates of 74.0% and 70.0% at 6 and 12 months respectively. EFFICACY At the last follow-up, there was a ≥ 50% responder rate of 30.8%, with 12.1% seizure-free. Seizure frequency categories improved in 31.4% of patients, remained the same in 44.2%, and worsened in 24.4%. Monthly tonic-clonic seizure frequency had significantly decreased, and of those reporting these seizures, 58.3% showed reductions and 25.0% showed complete tonic-clonic seizure freedom. TOLERABILITY 91.7% of patients reported at least 1 TEAE, with fatigue (30.3%), irritability (29.4%), and depression/low mood (28.4%) as the most common. Only 58.4% of all TEAEs were persistent. Brivaracetam discontinuation due to side effects occurred in 27.5% of the cohort. Depression and anxiety scores remained stable over time, and quality-of-life scores improved. Subgroups: Measures of BRV efficacy and tolerability did not differ according to previous LEV exposure. Tolerability profiles of those with learning disabilities, histories of psychiatric comorbidities, and older age did not greatly differ from the rest of the cohort. Of note, specific history of depression predicted the reporting of suicidal ideation. CONCLUSION The BRIVEST study provides real-world evidence of the effectiveness of BRV, suggesting that neither drug-resistant epilepsy nor previous LEV failure should preclude its use. Furthermore, BRV appears to be well-tolerated, even among those from vulnerable patient populations.
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Affiliation(s)
- Sophie Naddell
- Department of Neurology, Southmead Hospital, North Bristol NHS Trust, United Kingdom.
| | - Megan Manuel
- Department of Neurology, Southmead Hospital, North Bristol NHS Trust, United Kingdom
| | - Rebecca Cavill
- Department of Neurology, Southmead Hospital, North Bristol NHS Trust, United Kingdom
| | - Paul White
- Department of Data Science and Mathematics, University of the West of England, Bristol, United Kingdom
| | - Katarzyna Sieradzan
- Department of Neurology, Southmead Hospital, North Bristol NHS Trust, United Kingdom
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Green SF, Hare N, Kassam M, Rugg-Gunn F, Koepp MJ, Sander JW, Rajakulendran S. Retention of brivaracetam in adults with drug-resistant epilepsy at a single tertiary care center. Epilepsy Behav 2022; 135:108868. [PMID: 35985166 DOI: 10.1016/j.yebeh.2022.108868] [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: 05/13/2022] [Revised: 06/30/2022] [Accepted: 07/29/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Brivaracetam (BRV) is licensed as an adjunctive treatment for focal epilepsy. We describe our clinical experience with BRV at a large UK tertiary center. METHODS Adults initiated on BRV between July 2015 and July 2020 were followed up until they discontinued BRV or September 2021. Data on epilepsy syndrome, duration, seizure types, concomitant and previous antiseizure medication (ASM) use, BRV dosing, efficacy, and side effects were recorded. Efficacy was categorized as temporary (minimum three months) or ongoing (at last follow-up) seizure freedom, ≥50% seizure reduction, or other benefits (e.g., no convulsions or daytime seizures). Brivaracetam retention was estimated using Kaplan-Meier survival analysis. RESULTS Two-hundred people were treated with BRV, of whom 81% had focal epilepsy. The mean (interquartile range [IQR]) follow-up time was 707 (688) days, and the dose range was 50-600 mg daily. The mean (IQR) of the previous number of used ASMs was 6.9 (6.0), and concomitant use was 2.2 (1.0). One-hundred and eighty-eight people (94%) had previously discontinued levetiracetam (LEV), mainly due to side effects. 13/200 (6.5%) were seizure free for a minimum of six months during treatment, and 46/200 (23%) had a ≥50% reduction in seizure frequency for six months or more. Retention rates were 83% at six months, 71% at 12 months, and 57% at 36 months. Brivaracetam was mostly discontinued due to side effects (38/75, 51%) or lack of efficacy (28/75, 37%). Concomitant use of carbamazepine significantly increased the hazard ratio of discontinuing BRV due to side effects (p = 0.006). The most commonly reported side effects were low mood (20.5%), fatigue (18%) and aggressive behavior (8.5%). These side effects were less prevalent than when the same individuals took LEV (low mood, 59%; aggressive behavior, 43%). Intellectual disability was a risk factor for behavioral side effects (p = 0.004), and a pre-existing mood disorder significantly increased the likelihood of further episodes of low mood (p = 0.019). CONCLUSIONS Brivaracetam was effective at a broad range of doses in managing drug-resistant epilepsy across various phenotypes, but less effective than LEV in those who switched due to poor tolerability on LEV. There were no new tolerability issues, but 77% of the individuals experiencing side effects on BRV also experienced similar side effects on LEV.
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Affiliation(s)
- Sebastian F Green
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Nisha Hare
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Mehreen Kassam
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom
| | - Fergus Rugg-Gunn
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom
| | - Matthias J Koepp
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom
| | - Josemir W Sander
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.
| | - Sanjeev Rajakulendran
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom
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Adjunctive Brivaracetam in Older Patients with Focal Seizures: Evidence from the BRIVAracetam add‑on First Italian netwoRk Study (BRIVAFIRST). Drugs Aging 2022; 39:297-304. [PMID: 35344198 PMCID: PMC8995268 DOI: 10.1007/s40266-022-00931-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/17/2022]
Abstract
Background The management of epilepsy in older adults has become part of daily practice because of an aging population. Older patients with epilepsy represent a distinct and more vulnerable clinical group as compared with younger patients, and they are generally under-represented in randomized placebo-controlled trials. Real-world studies can therefore be a useful complement to characterize the drug’s profile. Brivaracetam is a rationally developed compound characterized by high-affinity binding to synaptic vesicle protein 2A and approved as adjunctive therapy for focal seizures in adults with epilepsy. Objective The aim of this study was to assess the 12-month effectiveness and tolerability of adjunctive brivaracetam in older patients (≥65 years of age) with epilepsy treated in a real-world setting. Methods The BRIVAFIRST (BRIVAracetam add-on First Italian netwoRk STudy) was a 12-month retrospective multicenter study including adult patients prescribed adjunctive brivaracetam. Effectiveness outcomes included the rates of seizure response (≥50% reduction in baseline seizure frequency), seizure freedom, and treatment discontinuation. Safety and tolerability outcomes included the rate of treatment discontinuation due to adverse events and the incidence of adverse events. Data were compared for patients aged ≥65 years of age (‘older’) vs those aged <65 years (‘younger’). Results There were 1029 patients with focal epilepsy included in the study, of whom 111 (10.8%) were aged ≥65 years. The median daily dose of brivaracetam at 3 months was 100 [interquartile range, 100–175] mg in the older group and 100 [100–200] mg in the younger group (p = 0.036); it was 150 [100–200] mg in both groups either at 6 months (p = 0.095) or 12 months (p = 0.140). At 12 months, 49 (44.1%) older and 334 (36.4%) younger patients had a reduction in their baseline seizure frequency by at least 50% (p = 0.110), and the seizure freedom rates were 35/111 (31.5%) and 134/918 (14.6%) in older and younger groups, respectively (p < 0.001). During the 1-year study period, 20 (18.0%) patients in the older group and 245 (26.7%) patients in the younger group discontinued brivaracetam (p = 0.048). Treatment withdrawal because of insufficient efficacy was less common in older than younger patients [older: n = 7 (6.3%), younger: n = 152 (16.6%); p = 0.005]. Adverse events were reported by 24.2% of older patients and 30.8% of younger patients (p = 0.185); the most common adverse events were somnolence, nervousness and/or agitation, vertigo, and fatigue in both study groups. Conclusions Adjunctive brivaracetam was efficacious, had good tolerability, and no new or unexpected safety signals emerged when used to treat older patients with uncontrolled focal seizures in clinical practice. Adjunctive brivaracetam can be a suitable therapeutic option in this special population.
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Lattanzi S, Ascoli M, Canafoglia L, Canevini MP, Casciato S, Cerulli Irelli E, Chiesa V, Dainese F, De Maria G, Didato G, Di Gennaro G, Falcicchio G, Fanella M, Gangitano M, La Neve A, Mecarelli O, Montalenti E, Morano A, Piazza F, Pizzanelli C, Pulitano P, Ranzato F, Rosati E, Tassi L, Di Bonaventura C, Alicino A, Assenza G, Avorio F, Badioni V, Banfi P, Bartolini E, Manfredi Basili L, Belcastro V, Beretta S, Berto I, Biggi M, Billo G, Boero G, Bonanni P, Bongiorno J, Brigo F, Caggia E, Cagnetti C, Calvello C, Cesnik E, Chianale G, Ciampanelli D, Ciuffini R, Cocito D, Colella D, Contento M, Costa C, Cumbo E, D'Aniello A, Deleo F, DiFrancesco JC, Di Giacomo R, Di Liberto A, Domina E, Donato F, Dono F, Durante V, Elia M, Estraneo A, Evangelista G, Teresa Faedda M, Failli Y, Fallica E, Fattouch J, Ferrari A, Ferreri F, Fisco G, Fonti D, Fortunato F, Foschi N, Francavilla T, Galli R, Gasparini S, Gazzina S, Teresa Giallonardo A, Sean Giorgi F, Giuliano L, Habetswallner F, Izzi F, Kassabian B, Kiferle L, Labate A, Luisi C, Magliani M, Maira G, Mari L, Marino D, Mascia A, Mazzeo A, Meletti S, Milano C, Nilo A, Orlando B, Paladin F, Grazia Pascarella M, Pastori C, Pauletto G, Peretti A, Perri G, Pezzella M, Piccioli M, Pignatta P, Pilolli N, Pisani F, Rosa Pisani L, Placidi F, Pollicino P, Porcella V, Puligheddu M, Quadri S, Paolo Quarato P, Quintas R, Renna R, Rum A, Michele Salamone E, Savastano E, Sessa M, Stokelj D, Tartara E, Tombini M, Tumminelli G, Elisabetta Vaudano A, Ventura M, Viganò I, Viglietta E, Vignoli A, Villani F, Zambrelli E, Zummo L. Sustained seizure freedom with adjunctive brivaracetam in patients with focal‐onset seizures. Epilepsia 2022; 63:e42-e50. [PMID: 35278335 PMCID: PMC9311068 DOI: 10.1111/epi.17223] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Simona Lattanzi
- Neurological Clinic Department of Experimental and Clinical Medicine Marche Polytechnic University Ancona Italy
| | - Michele Ascoli
- Department of Medical and Surgical Sciences Magna Græcia University of Catanzaro Catanzaro Italy
| | - Laura Canafoglia
- Department of Epileptology Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Maria Paola Canevini
- Epilepsy Center Child Neuropsychiatry Unit AAST Santi Paolo Carlo Milan Italy
- Department of Health Sciences Università degli Studi Milan Italy
| | | | | | - Valentina Chiesa
- Epilepsy Center Child Neuropsychiatry Unit AAST Santi Paolo Carlo Milan Italy
| | | | - Giovanni De Maria
- Clinical Neurophysiology Unit, Epilepsy Center Spedali Civili Brescia Italy
| | - Giuseppe Didato
- Epilepsy Unit Fondazione IRCCS Istituto Neurologico "Carlo Besta" Milan Italy
| | | | - Giovanni Falcicchio
- Department of Basic Medical Sciences Neurosciences and Sense Organs‐ University Hospital of Bari “A. Moro”
| | - Martina Fanella
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | - Massimo Gangitano
- Department of Biomedicine Neuroscience, and advanced Diagnostic (BIND) University of Palermo Palermo Italy
| | - Angela La Neve
- Department of Basic Medical Sciences Neurosciences and Sense Organs‐ University Hospital of Bari “A. Moro”
| | - Oriano Mecarelli
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | - Elisa Montalenti
- Epilepsy Center AOU Città della Salute e della Scienza di Torino Turin Italy
| | - Alessandra Morano
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | - Federico Piazza
- Rita Levi Montalcini Department of Neurosciences University of Turin Turin Italy
| | - Chiara Pizzanelli
- Department of Clinical and Experimental Medicine Neurological Clinic University of Pisa Pisa, Pisa Italy
| | - Patrizia Pulitano
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | | | - Eleonora Rosati
- Department Neurology 2 Careggi University Hospital Florence Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Centre Niguarda Hospital Milan Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
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Lattanzi S, Canafoglia L, Canevini MP, Casciato S, Irelli EC, Chiesa V, Dainese F, De Maria G, Didato G, Di Gennaro G, Falcicchio G, Fanella M, Ferlazzo E, Gangitano M, La Neve A, Mecarelli O, Montalenti E, Morano A, Piazza F, Pizzanelli C, Pulitano P, Ranzato F, Rosati E, Tassi L, Di Bonaventura C, Alicino A, Ascoli M, Assenza G, Avorio F, Badioni V, Banfi P, Bartolini E, Basili LM, Belcastro V, Beretta S, Berto I, Biggi M, Billo G, Boero G, Bonanni P, Bongorno J, Brigo F, Caggia E, Cagnetti C, Calvello C, Cesnik E, Chianale G, Ciampanelli D, Ciuffini R, Cocito D, Colella D, Contento M, Costa C, Cumbo E, D'Aniello A, Deleo F, DiFrancesco JC, Di Giacomo R, Di Liberto A, Domina E, Dono F, Durante V, Elia M, Estraneo A, Evangelista G, Faedda MT, Failli Y, Fallica E, Fattouch J, Ferrari A, Ferreri F, Fisco G, Fonti D, Fortunato F, Foschi N, Francavilla T, Galli R, Gazzina S, Giallonardo AT, Giorgi FS, Giuliano L, Habetswallner F, Izzi F, Kassabian B, Labate A, Luisi C, Magliani M, Maira G, Mari L, Marino D, Mascia A, Mazzeo A, Milano C, Meletti S, Nilo A, Orlando B, Paladin F, Pascarella MG, Pastori C, Pauletto G, Peretti A, Perri G, Pezzella M, Piccioli M, Pignatta P, Pilolli N, Pisani F, Pisani LR, Placidi F, Pollicino P, Porcella V, Pradella S, Puligheddu M, Quadri S, Quarato PP, Quintas R, Renna R, Rizzo GR, Rum A, Salamone EM, Savastano E, Sessa M, Stokelj D, Tartara E, Tombini M, Tumminelli G, Vaudano AE, Ventura M, Viganò I, Viglietta E, Vignoli A, Villani F, Zambrelli E, Zummo L. Brivaracetam as add-on treatment in patients with post-stroke epilepsy: real-world data from the BRIVAracetam add-on First Italian netwoRk Study (BRIVAFIRST). Seizure 2022; 97:37-42. [DOI: 10.1016/j.seizure.2022.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 12/12/2022] Open
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Lattanzi S, Chiesa V, Ferlazzo E, La Neve A, Pignatta P, Di Bonaventura C. Clinical predictors of response to adjunctive brivaracetam: Insights from real-world data. Epilepsia 2021; 63:252-253. [PMID: 34778953 DOI: 10.1111/epi.17123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Simona Lattanzi
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| | - Valentina Chiesa
- Child Neuropsychiatry Unit, Epilepsy Center, AAST Santi Paolo Carlo, Milan, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Angela La Neve
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University Hospital of Bari "A. Moro,", Bari, Italy
| | - Pietro Pignatta
- Neurology and Epilepsy Unit, Humanitas Gradenigo Hospital, Turin, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Umberto I Polyclinic, Sapienza University of Rome, Rome, Italy
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Strzelczyk A, Zaveta C, von Podewils F, Möddel G, Langenbruch L, Kovac S, Mann C, Willems LM, Schulz J, Fiedler B, Kurlemann G, Schubert-Bast S, Rosenow F, Beuchat I. Long-term efficacy, tolerability, and retention of brivaracetam in epilepsy treatment: A longitudinal multicenter study with up to 5 years of follow-up. Epilepsia 2021; 62:2994-3004. [PMID: 34608628 DOI: 10.1111/epi.17087] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study was undertaken to evaluate the long-term efficacy, retention, and tolerability of add-on brivaracetam (BRV) in clinical practice. METHODS A multicenter, retrospective cohort study recruited all patients who initiated BRV between February and November 2016, with observation until February 2021. RESULTS Long-term data for 262 patients (mean age = 40 years, range = 5-81 years, 129 men) were analyzed, including 227 (87%) diagnosed with focal epilepsy, 19 (7%) with genetic generalized epilepsy, and 16 (6%) with other or unclassified epilepsy syndromes. Only 26 (10%) patients had never received levetiracetam (LEV), whereas 133 (50.8%) were switched from LEV. The length of BRV exposure ranged from 1 day to 5 years, with a median retention time of 1.6 years, resulting in a total BRV exposure time of 6829 months (569 years). The retention rate was 61.1% at 12 months, with a reported efficacy of 33.1% (79/239; 50% responder rate, 23 patients lost-to-follow-up), including 10.9% reported as seizure-free. The retention rate for the entire study period was 50.8%, and at last follow-up, 133 patients were receiving BRV at a mean dose of 222 ± 104 mg (median = 200, range = 25-400), including 52 (39.1%) who exceeded the recommended upper dose of 200 mg. Fewer concomitant antiseizure medications and switching from LEV to BRV correlated with better short-term responses, but no investigated parameters correlated with positive long-term outcomes. BRV was discontinued in 63 (24%) patients due to insufficient efficacy, in 29 (11%) for psychobehavioral adverse events, in 25 (10%) for other adverse events, and in 24 (9%) for other reasons. SIGNIFICANCE BRV showed a clinically useful 50% responder rate of 33% at 12 months and overall retention of >50%, despite 90% of included patients having previous LEV exposure. BRV was well tolerated; however, psychobehavioral adverse events occurred in one out of 10 patients. Although we identified short-term response and retention predictors, we could not identify significant predictors for long-term outcomes.
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Affiliation(s)
- Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Clara Zaveta
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix von Podewils
- Epilepsy Center Greifswald and Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Gabriel Möddel
- Epilepsy Center Münster-Osnabrück, Department of Neurology With Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Lisa Langenbruch
- Epilepsy Center Münster-Osnabrück, Department of Neurology With Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Stjepana Kovac
- Epilepsy Center Münster-Osnabrück, Department of Neurology With Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Catrin Mann
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Juliane Schulz
- Epilepsy Center Greifswald and Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Barbara Fiedler
- Department of Neuropediatrics, University of Münster, Münster, Germany
| | - Gerhard Kurlemann
- Department of Neuropediatrics, University of Münster, Münster, Germany.,St. Bonifatius Hospital, Lingen, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany.,Department of Neuropediatrics, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Isabelle Beuchat
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
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