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Espinosa-Jovel C, Valencia N, Gaitán L, Riveros S. Impact of Third-Generation Antiseizure Medications on People with Epilepsy in a Low-Income Population: The Brivaracetam Experience in a Real-World Study. Drugs Real World Outcomes 2024; 11:477-485. [PMID: 39039377 DOI: 10.1007/s40801-024-00445-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Third-generation antiseizure medications, such as brivaracetam, are recognized for their superior safety, tolerability, and pharmacokinetic profiles. However, their potential benefits are often limited in low-income populations because of challenges related to availability and affordability. OBJECTIVE We aimed to evaluate the effectiveness and safety of brivaracetam for treating epilepsy in a low-income population, within a real-world setting. METHODS This retrospective cohort study included individuals with epilepsy from a low-income population in Bogotá, Colombia, who were treated with brivaracetam between January 2020 and July 2023. Effectiveness (mean seizure reduction and ≥ 50% seizure reduction) and safety (retention rate and adverse events) were evaluated. RESULTS A total of 106 individuals were included, with a median age of 33 years (interquartile range: 24-44). Most had focal epilepsy with a median disease duration of 25.4 years (standard deviation: 13.6). The baseline seizure frequency was 4 seizures per month (interquartile range: 2-15) and individuals had previously received a mean of 4.4 (standard deviation: 1.8) antiseizure medications. The mean percentage seizure reduction at 3, 6, and 12 months was 55.3%, 66.9%, and 63.8%, respectively. Additionally, 60%, 63.8%, and 65.9% of individuals achieved a ≥ 50% seizure reduction at 3, 6, and 12 months, respectively. Retention rate at 3 months was 89% (n = 95) and 18.7% (n = 20) reported adverse effects. CONCLUSIONS In a real-world setting, brivaracetam has been shown to be safe and effective for the treatment of epilepsy in individuals from a low-income population. This study suggests that people with epilepsy living in this context can significantly benefit from the use of third-generation antiseizure medications.
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Affiliation(s)
- Camilo Espinosa-Jovel
- Epilepsy Program, Hospital de Kennedy, Subred de Servicios de Salud Sur Occidente, Av. 1 de Mayo #40B-54, Hospital de Kennedy, Epilepsy Program, Bogotá, Colombia.
- Neurology Postgraduate Program, Universidad de la Sabana, Chía, Colombia.
| | - Natalia Valencia
- Neurology Postgraduate Program, Universidad de la Sabana, Chía, Colombia
| | - Lisa Gaitán
- Neurology Postgraduate Program, Universidad de la Sabana, Chía, Colombia
| | - Sandra Riveros
- Epilepsy Program, Hospital de Kennedy, Subred de Servicios de Salud Sur Occidente, Av. 1 de Mayo #40B-54, Hospital de Kennedy, Epilepsy Program, Bogotá, Colombia
- Neurology Postgraduate Program, Universidad de la Sabana, Chía, Colombia
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2
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Jukier T, Zhang C, Arnold RD, Gross A. Single intravenous and oral dose pharmacokinetics of the antiseizure medication brivaracetam in healthy cats. J Vet Pharmacol Ther 2024. [PMID: 39018069 DOI: 10.1111/jvp.13473] [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: 02/02/2024] [Revised: 06/16/2024] [Accepted: 07/02/2024] [Indexed: 07/18/2024]
Abstract
The number of available antiseizure medications with demonstrated efficacy in cats is limited. As such, there is a need to evaluate the pharmacokinetics of newer medications so that proper dosing regimens can be made. Brivaracetam (BRV) is a more potent analogue of levetiracetam, and is Food and Drug Administration approved for use in people. The goal of this study was to describe the pharmacokinetics of intravenous and oral doses of BRV in healthy cats. A cross-over study involving eight healthy cats, that were administered 10 mg of BRV intravenously as a bolus and orally in the fasted state. Blood samples were collected over 24 h. Analysis was performed using liquid chromatography-mass spectrometry. Data were subjected to non-compartmental analysis. Median (min-max) of maximal concentration, time to maximal concentration, area under the curve, elimination half-life and oral absolute bioavailability were 902 (682-1036) ng/mL, 0.6 (0.5-2.0) h, 6.4 (5.2-7.2) h, 8145 (6669-9351) ng × h/mL and 100% (85-110) respectively. BRV appeared to be well tolerated by all cats. A single dose of BRV is well tolerated both orally and intravenously. Maximal concentrations are produced rapidly and within the human reference interval considered to be therapeutic.
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Affiliation(s)
- Tom Jukier
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA
| | - Chu Zhang
- Drug Discovery and Development Research, Harrison College of Pharmacy, Auburn University, Auburn, Alabama, USA
| | - Robert D Arnold
- Drug Discovery and Development Research, Harrison College of Pharmacy, Auburn University, Auburn, Alabama, USA
| | - Amanda Gross
- Scott-Ritchey Research Center, College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA
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3
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Harlan SS, Philpott CD, Keegan SP, Droege ME, Karve AS, Foreman B, Wakefield D, Mueller EW, Sangha K, Ngwenya LB, Courter JD, Desai P, Droege C. Pharmacokinetics of Levetiracetam Seizure Prophylaxis in Severe Traumatic Brain Injury. Ann Pharmacother 2024; 58:705-714. [PMID: 37776163 DOI: 10.1177/10600280231202246] [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] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Drug pharmacokinetics (PK) are altered in neurocritically ill patients, and optimal levetiracetam dosing for seizure prophylaxis is unknown. OBJECTIVE This study evaluates levetiracetam PK in critically ill patients with severe traumatic brain injury (sTBI) receiving intravenous levetiracetam 1000 mg every 8 (LEV8) to 12 (LEV12) hours for seizure prophylaxis. METHODS This prospective, open-label study was conducted at a level 1 trauma, academic, quaternary care center. Patients with sTBI receiving seizure prophylaxis with LEV8 or LEV12 were eligible for enrollment. Five sequential, steady-state, postdose serum levetiracetam concentrations were obtained. Non-compartmental analysis (NCA) and compartmental approaches were employed for estimating pharmacokinetic parameters and projecting steady-state trough concentrations. Pharmacokinetic parameters were compared between LEV8 and LEV12 patients. Monte Carlo simulations (MCS) were performed to determine probability of target trough attainment (PTA) of 6 to 20 mg/L. A secondary analysis evaluated PTA for weight-tiered levetiracetam dosing. RESULTS Ten male patients (5 LEV8; 5 LEV12) were included. The NCA-based systemic clearance and elimination half-life were 5.3 ± 1.2 L/h and 4.8 ± 0.64 hours. A one-compartment model provided a higher steady-state trough concentration for the LEV8 group compared with the LEV12 group (13.7 ± 4.3 mg/L vs 6.3 ± 1.7 mg/L; P = 0.008). Monte Carlo simulations predicted regimens of 500 mg every 6 hours, 1000 mg every 8 hours, and 2000 mg every 12 hours achieved therapeutic target attainment. Weight-tiered dosing regimens achieved therapeutic target attainment using a 75 kg breakpoint. CONCLUSION AND RELEVANCE Neurocritically ill patients exhibit rapid levetiracetam clearance resulting in a short elimination half-life. Findings of this study suggest regimens of levetiracetam 500 mg every 6 hours, 1000 mg every 8 hours, or 2000 mg every 12 hours may be required for optimal therapeutic target attainment. Patient weight of 75 kg may serve as a breakpoint for weight-guided dosing to optimize levetiracetam therapeutic target attainment for seizure prophylaxis.
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Affiliation(s)
- Sarah Schuman Harlan
- Department of Pharmacy Services, Baptist Memorial Hospital, Memphis, TN, USA
- Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, Memphis, TN, USA
| | - Carolyn D Philpott
- Department of Pharmacy Services, UC Health-University of Cincinnati Medical Center, Cincinnati, OH, USA
- Division of Pharmacy Practice & Administrative Sciences, James L Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
| | | | - Molly E Droege
- Department of Pharmacy Services, UC Health-University of Cincinnati Medical Center, Cincinnati, OH, USA
- Division of Pharmacy Practice & Administrative Sciences, James L Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
| | - Aniruddha S Karve
- Division of Pharmaceutical Sciences, James L Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
| | - Brandon Foreman
- Division of Neurocritical Care, Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Devin Wakefield
- Division of Trauma and Surgical Critical Care, Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Eric W Mueller
- Department of Pharmacy Services, UC Health-University of Cincinnati Medical Center, Cincinnati, OH, USA
- Division of Pharmacy Practice & Administrative Sciences, James L Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
| | - Kiranpal Sangha
- Department of Pharmacy Services, UC Health-University of Cincinnati Medical Center, Cincinnati, OH, USA
- Division of Pharmacy Practice & Administrative Sciences, James L Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
- Community of Scholars Faculty, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Laura B Ngwenya
- Department of Neurosurgery, Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Joshua D Courter
- Department of Pharmacy Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Pankaj Desai
- Division of Pharmaceutical Sciences, James L Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
| | - Christopher Droege
- Department of Pharmacy Services, UC Health-University of Cincinnati Medical Center, Cincinnati, OH, USA
- Division of Pharmacy Practice & Administrative Sciences, James L Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
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4
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Farooq T, Javaid S, Ashraf W, Rasool MF, Anjum SMM, Sabir A, Ahmad T, Alqarni SA, Alqahtani F, Imran I. Neuroprotective Effect of Brivaracetam and Perampanel Combination on Electrographic Seizures and Behavior Anomalies in Pentylenetetrazole-Kindled Mice. ACS OMEGA 2024; 9:26004-26019. [PMID: 38911714 PMCID: PMC11191135 DOI: 10.1021/acsomega.4c00962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/12/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024]
Abstract
Pentylenetetrazole (PTZ)-induced kindling is a broadly used experimental model to study the anticonvulsive potential of new and existing chemical moieties with the aim of discovering drugs hindering seizure progression and associated neurological comorbidities. In the present study, the impact of brivaracetam (BRV) (10 and 20 mg/kg) as monotherapy as well as in combination with 0.25 mg/kg of perampanel (PRP) was investigated on seizure progression with simultaneous electroencephalographic changes in PTZ kindling mouse model. Subsequently, mice were experimentally analyzed for anxiety, cognition, and depression after which their brains were biochemically evaluated for oxidative stress. The outcomes demonstrated that BRV alone delayed the kindling process, but BRV + PRP combination significantly (p < 0.0001) protected the mice from seizures of higher severity and demonstrated an antikindling effect. The PTZ-kindled mice exhibited anxiety, memory impairment, and depression in behavioral tests, which were remarkably less (p < 0.001) in animals treated with drug combination (in a dose-dependent manner) as these mice explored central, illuminated, and exposed zones of open-field test, light/dark box, and elevated plus maze. Moreover, memory impairment was demonstrated by kindled mice, which was significantly (p < 0.001) protected by BRV + PRP as animal's spontaneous alteration, object discrimination, and step-through latencies were increased in various tests employed for the assessment of cognitive abilities. The brains of PTZ-kindled mice had increased malondialdehyde and reduced antioxidant enzymes while treatment with BRV + PRP combination prevented kindling-induced elevation in oxidative markers. The outcomes of this study demonstrate that combining the PRP at low dose augmented the antiseizure properties of BRV as both drugs when administered simultaneously hindered the process of kindling by reducing PTZ-induced excessive electrical activity and oxidative stress in the brain.
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Affiliation(s)
- Talha Farooq
- Department
of Pharmacology, Faculty of Pharmacy, Bahauddin
Zakariya University, Multan 60800, Pakistan
| | - Sana Javaid
- Department
of Pharmacology, Faculty of Pharmacy, Bahauddin
Zakariya University, Multan 60800, Pakistan
- Department
of Pharmacy, The Women University, Multan 60000, Pakistan
| | - Waseem Ashraf
- Department
of Pharmacology, 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
| | - Syed Muhammad Muneeb Anjum
- The
Institute of Pharmaceutical Sciences, University
of Veterinary & Animal Sciences, Lahore 75270, Pakistan
| | - Azka Sabir
- Department
of Pharmacology, Faculty of Pharmacy, Bahauddin
Zakariya University, Multan 60800, Pakistan
| | - Tanveer Ahmad
- Institut
pour l’Avancée des Biosciences, Centre de Recherche
UGA/INSERM U1209/CNRS 5309, Université
Grenoble Alpes, Saint-Martin-d’Heres 38400, France
| | - Saleh A. Alqarni
- Department
of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Faleh Alqahtani
- Department
of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Imran Imran
- Department
of Pharmacology, Faculty of Pharmacy, Bahauddin
Zakariya University, Multan 60800, Pakistan
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5
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Alok K, Lin A, Rahman Dematteo C, Abrar H, Levy Z. Brivaracetam-Associated Rhabdomyolysis Requiring Renal Replacement Therapy: A Case Report and Review of the Literature. Cureus 2024; 16:e58183. [PMID: 38741805 PMCID: PMC11089833 DOI: 10.7759/cureus.58183] [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] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
Rhabdomyolysis is a rare adverse reaction that has a previously established association with levetiracetam use, which selectively binds the synaptic vesicle glycoprotein 2A (SV2A). Its structural analogue, brivaracetam, is a new third-generation antiseizure medication that has a higher affinity for SV2A, and current data suggests it provides a more favorable adverse event profile. Here, however, we report a case of rhabdomyolysis requiring dialysis in which serum creatine kinase level increased rapidly for several days until brivaracetam was discontinued. The delayed creatine kinase peak, rapid decline upon discontinuation of brivaracetam, and prior association of rhabdomyolysis with levetiracetam strongly suggest a causal relationship. To date, there are three reported cases of brivaracetam-associated rhabdomyolysis in the food and drugs administration adverse event reporting system (FAERS). Despite its favorable side effects profile, the use of brivaracetam may be associated with life-threatening rhabdomyolysis.
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Affiliation(s)
- Khaled Alok
- Neurocritical Care, Northwell Health, Manhasset, USA
| | - Amanda Lin
- Pharmacy, Neurocritical Care, Northwell Health, Manhassett, USA
| | | | - Husain Abrar
- Internal Medicine, Northwell Health, Manhasset, USA
| | - Zachary Levy
- Neurocritical Care, Northwell Health, Manhasset, USA
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6
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Kassoum A, Intravooth T, Wendling AS, Staack AM, Steinhoff BJ. Psychiatric assessment prior to and after switch from levetiracetam to brivaracetam. Seizure 2024; 117:193-197. [PMID: 38460458 DOI: 10.1016/j.seizure.2024.02.022] [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: 09/03/2023] [Revised: 02/14/2024] [Accepted: 02/28/2024] [Indexed: 03/11/2024] Open
Abstract
PURPOSE Brivaracetam is often used as an alternative to levetiracetam in patients with epilepsy (PWE) encountering efficacy issues or adverse events with levetiracetam. This study evaluated the psychological status of PWE who were switched from levetiracetam to brivaracetam due to psychiatric tolerability concerns in comparison to those who remained on levetiracetam. METHODS We used various psychological assessments including the Symptom Checklist SCL-90-R, the Beck Depression Inventory-II, and the adverse event profile. Eligible participants completed the questionnaires at baseline and again 8 days later. Psychological changes were assessed using standard statistical methods to show differences between a group that immediately switched from levetiracetam to brivaracetam and another group with unchanged levetiracetam. RESULTS Between May 2020 and May 2021, 63 patients participated in the study, of whom 34 switched from levetiracetam to brivaracetam. At baseline, participants who switched to brivaracetam had fewer antiseizure medications but experienced more monthly seizures. Baseline scores for anxiety (p = 0.020) and psychoticism (p = 0.046) on SCL-90-R in PWE switched to brivaracetam were higher than in the remaining group. In the subsequent assessment, all psychological scores were reduced and were no longer significantly different between both groups. Using multiple regression, initial treatment with a single antiseizure medication and male gender emerged as predictors of psychological improvement. CONCLUSION Our study found no increased risk of adverse events or psychiatric symptoms after switching from levetiracetam to brivaracetam. Though statistically non-significant, a trend towards improved psychiatric outcomes in the switch group warrants further investigation in future trials with stronger designs for enhanced statistical power.
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Affiliation(s)
- Ammar Kassoum
- Department of Adult Epilepsy, Kork Epilepsy Center, Landstr. 1, Kehl-Kork, Germany; Department of Neurology and Clinical Neuroscience, Medical Faculty, University of Freiburg, Breisacher Str. 64, Freiburg, Germany
| | - Tassanai Intravooth
- Department of Adult Epilepsy, Kork Epilepsy Center, Landstr. 1, Kehl-Kork, Germany.
| | - Anne-Sophie Wendling
- Department of Adult Epilepsy, Kork Epilepsy Center, Landstr. 1, Kehl-Kork, Germany
| | - Anke M Staack
- Department of Adult Epilepsy, Kork Epilepsy Center, Landstr. 1, Kehl-Kork, Germany
| | - Bernhard J Steinhoff
- Department of Adult Epilepsy, Kork Epilepsy Center, Landstr. 1, Kehl-Kork, Germany; Department of Neurology and Clinical Neuroscience, Medical Faculty, University of Freiburg, Breisacher Str. 64, Freiburg, Germany
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7
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Wang SJ, Zhao MY, Zhao PC, Zhang W, Rao GW. Research Status, Synthesis and Clinical Application of Antiepileptic Drugs. Curr Med Chem 2024; 31:410-452. [PMID: 36650655 DOI: 10.2174/0929867330666230117160632] [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: 06/14/2022] [Revised: 10/25/2022] [Accepted: 11/03/2022] [Indexed: 01/19/2023]
Abstract
According to the 2017 ILAE's official definition, epilepsy is a slow brain disease state characterized by recurrent episodes. Due to information released by ILAE in 2017, it can be divided into four types, including focal epilepsy, generalized epilepsy, combined generalized, and focal epilepsy, and unknown epilepsy. Since 1989, 24 new antiepileptic drugs have been approved to treat different types of epilepsy. Besides, there are a variety of antiepileptic medications under clinical monitoring. These novel antiepileptic drugs have plenty of advantages. Over the past 33 years, there have been many antiepileptic drugs on the mearket, but no one has been found that can completely cure epilepsy. In this paper, the mentioned drugs were classified according to their targets, and the essential information, and clinical studies of each drug were described. The structure-activity relationship of different chemical structures was summarized. This paper provides help for the follow-up research on epilepsy drugs.
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Affiliation(s)
- Si-Jie Wang
- College of Pharmaceutical Science, Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou 310014, P.R. China
| | - Min-Yan Zhao
- College of Pharmaceutical Science, Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou 310014, P.R. China
| | - Peng-Cheng Zhao
- College of Pharmaceutical Science, Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou 310014, P.R. China
| | - Wen Zhang
- College of Pharmaceutical Science, Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou 310014, P.R. China
| | - Guo-Wu Rao
- College of Pharmaceutical Science, Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou 310014, P.R. China
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8
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Watkins LV, Dunstall H, Musicha C, Lawthom C, John K, Bright C, Richings C, Harding K, Moon S, Pape SE, Winterhalder R, Allgar V, Thomas RH, McLean B, Laugharne R, Shankar R. Rapid switching from levetiracetam to brivaracetam in pharmaco-resistant epilepsy in people with and without intellectual disabilities: a naturalistic case control study. J Neurol 2023; 270:5889-5902. [PMID: 37610448 DOI: 10.1007/s00415-023-11959-w] [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: 08/02/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Approximately one quarter of people with an intellectual disability (PwID) have epilepsy of whom nearly three-quarters are pharmaco-resistant. There are higher reported neuropsychiatric side-effects to anti-seizure medication (ASM) in this group. Levetiracetam (LEV) is a first-line ASM with a stronger association with neuropsychiatric symptoms for PwID than other ASMs. Brivaracetam (BRV) is a newer ASM. Recent studies suggest a beneficial effect of swapping people who experience neuropsychiatric events with LEV to BRV. However, there is limited evidence of this for PwID. This evaluation analyses real world outcomes of LEV to BRV swap for PwID compared to those without ID. METHODS We performed a multicentre, retrospective review of clinical records. Demographic, clinical characteristics and reported adverse events of patients switched from LEV to BRV (2016-2020) were recorded at 3 months pre and 6- and 12-month post-BRV initiation. Outcomes were compared between PwID and those without and summarised using cross-tabulations and logistic regression models. A Bonferroni correction was applied. RESULTS Of 77 participants, 46 had ID and 52% had a past psychiatric illness. 71% participants switched overnight from LEV to BRV. Seizure reduction of > 50% was seen in 40% patients. Psychiatric illness history was predictive of having neuropsychiatric side-effects with LEV but not BRV (p = 0.001). There was no significant difference for any primary outcomes between PwID versus without ID. CONCLUSIONS Switching from LEV to BRV appears as well tolerated and efficacious in PwID as those without ID with over 90% still on BRV after 12 months.
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Affiliation(s)
- L V Watkins
- Swansea Bay University Health Board, Port Talbot, UK
- University of South Wales, Aberdare, UK
- University of Plymouth, Plymouth, UK
| | - H Dunstall
- Swansea Bay University Health Board, Port Talbot, UK
| | - C Musicha
- University of Plymouth, Plymouth, UK
| | - C Lawthom
- Aneurin Bevan University Health Board, Newport, UK
- Swansea University, Swansea, UK
| | - K John
- Aneurin Bevan University Health Board, Newport, UK
| | - C Bright
- University of South Wales, Aberdare, UK
- Aneurin Bevan University Health Board, Newport, UK
| | - C Richings
- Aneurin Bevan University Health Board, Newport, UK
| | - K Harding
- Aneurin Bevan University Health Board, Newport, UK
| | - S Moon
- Swansea Bay University Health Board, Port Talbot, UK
| | - S E Pape
- Oxleas NHS Foundation Trust, Kent, UK
| | | | - V Allgar
- University of Plymouth, Plymouth, UK
| | - R H Thomas
- Newcastle University, Newcastle upon Tyne, UK
- The Newcastle Upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, UK
| | - B McLean
- University of Plymouth, Plymouth, UK
| | | | - Rohit Shankar
- University of Plymouth, Plymouth, UK.
- Cornwall Partnership NHS Foundation Trust, Threemilestone Industrial Estate, Truro, TR4 9LD, UK.
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9
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Chen J, Shen Y, Xia H, Chen X, Xu RA, Lin G, Dai G. Development of a UPLC-MS/MS method for the determination of lacosamide and its metabolite and its application to drug-drug interaction. Front Pharmacol 2023; 14:1265252. [PMID: 38026954 PMCID: PMC10667685 DOI: 10.3389/fphar.2023.1265252] [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: 07/22/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Lacosamide, a third-generation novel antiepileptic drug, was first approved in 2008 as an adjunct to partial seizures. In 2014, the U.S. Food and Drug Administration (FDA) approved it as a single agent for partial seizures. Since epilepsy is a chronic condition, most patients need long-term antiepileptic medicinal products, so it is even more important to consider the drug-drug interactions (DDIs). For the purpose of this experiment, an ultra performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) assay with accuracy and simplicity was optimized and fully validated for the simultaneous quantitative determination of lacosamide and O-Desmethyl-lacosamide (ODL), and DDIs between lacosamide and nisoldipine in vivo and in vitro was researched. The protein was precipitated with acetonitrile, the analytes were eluted with acetonitrile and a 0.1% formic acid solution in a gradient program, and lacosamide, ODL, and lamotrigine (Internal Standard, IS) were successfully separated by chromatography. The findings of the biological analysis revealed that the lower limit of quantification (LLOQ) for lacosamide in samples was 2 ng/mL and the linearity ranged from 2 to 10000 ng/mL. The LLOQ for ODL was 1 ng/mL, while the linearity range for this substance was 1-1,000 ng/mL. In rat liver microsomes (RLM), the LLOQ of ODL was 80 ng/mL and the linear range was 80-40000 ng/mL. The selectivity, stability, matrix effect and recovery rate were all satisfied with the need of quantitative analysis of samples. Then, the UPLC-MS/MS assay was employed successfully on the interactions of lacosamide and nisoldipine in vivo and in vitro. The half-maximal inhibitory concentration (IC50) was 3.412 μM in RLM, where nisoldipine inhibited the metabolism of lacosamide with a mixture of inhibition mechanism. In rat pharmacokinetic experiments, it was found that nisoldipine could significantly change the pharmacokinetic characteristics of lacosamide, including AUC(0-t), AUC(0-∞), Tmax, CLz/F and Cmax, but had no significant effect on ODL. In summary, the UPLC-MS/MS method could accurately and sensitively quantify lacosamide and ODL, and could be used for the interaction between nisoldipine and lacosamide in vivo and in vitro.
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Affiliation(s)
- Jie Chen
- Department of Pharmacy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yuxin Shen
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hailun Xia
- Department of Pharmacy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaohai Chen
- Department of Pharmacy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ren-Ai Xu
- Department of Pharmacy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Guanyang Lin
- Department of Pharmacy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Gexin Dai
- Department of Pharmacy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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10
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Martellino C, Laganà A, Atanasio G, Lamanna F, Attardo S, Cascino S, De Luca M, Pardeo O, Giacobbe G, Tripepi G, Roberti R, Granata F, Morace C, Russo E, Labate A. The real-world effectiveness of intravenous brivaracetam as a second-line treatment in status epilepticus. Epilepsy Behav 2023; 148:109464. [PMID: 37839249 DOI: 10.1016/j.yebeh.2023.109464] [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: 08/08/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE Status epilepticus (SE) is defined by abnormally prolonged seizures that may lead to brain damage and death. Our aim was to evaluate the efficacy and tolerability (effectiveness) of intravenous brivaracetam (BRV) as a second-line treatment. METHODS Twenty-one patients (median age 68 years ± 17.28) were prospectively recruited between June 2019 and December 2022. Patients were treated with BRV (50-200 mg) as a second-line add-on therapy for SE. We evaluated the response of SE to the administration of BRV in terms of SE termination and recurrence of epileptic seizures at 6, 12, and 24 h, also monitoring safety. The first-line therapy was represented by intravenous benzodiazepines (mainly diazepam). RESULTS Almost a quarter of patients had generalized seizures, whereas the vast majority (76.2%) presented focal seizures. In 52.4% of patients, the underlying cause was cerebrovascular. Fourteen (66.7%) patients displayed a good early response in the subsequent 6 h. At 12 and 24 h, 8 (38%) and 11 (52.4%) patients, respectively, did not present seizures. CONCLUSION The present study highlights the potential of BRV when used as an early add-on therapy in SE, further confirming its good safety profile.
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Affiliation(s)
- Chiara Martellino
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Angelina Laganà
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy; Regional Epilepsy Center, University of Messina, Messina, Italy
| | - Giorgia Atanasio
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Fabio Lamanna
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Silvia Attardo
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Simona Cascino
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Marcella De Luca
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Orazio Pardeo
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Giuseppa Giacobbe
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Giovanni Tripepi
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy
| | - Roberta Roberti
- Science of Health Department, University Magna Grecia of Catanzaro, Catanzaro, Italy
| | | | - Carmela Morace
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Emilio Russo
- Science of Health Department, University Magna Grecia of Catanzaro, Catanzaro, Italy
| | - Angelo Labate
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy; Regional Epilepsy Center, University of Messina, Messina, Italy.
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11
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Wang Z, Liao S, Chen H, Wu S, Liu Z, Liu Y, Hu T, Sun J, Wang K, Xin L, Cai J, Li Y. Identification, synthesis, and characterization of thermal degradants of brivaracetam. SYNTHETIC COMMUN 2023; 53:1601-1615. [DOI: 10.1080/00397911.2023.2238224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Indexed: 12/07/2023]
Affiliation(s)
- Zhongqing Wang
- School of Pharmacy, Xiangnan University, Chenzhou, P. R. China
- Department of Process Research and Development, HEC Pharm Group, Dongguan, P. R. China
- State Key Laboratory of Anti-Infective Drug Development (NO. 2015DQ780357), Sunshine Lake Pharma Co., Ltd, Dongguan, P. R. China
| | - Shouzhu Liao
- Department of Process Research and Development, HEC Pharm Group, Dongguan, P. R. China
| | - Hongjun Chen
- Department of Process Research and Development, HEC Pharm Group, Dongguan, P. R. China
| | - Shuming Wu
- Department of Process Research and Development, HEC Pharm Group, Dongguan, P. R. China
- State Key Laboratory of Anti-Infective Drug Development (NO. 2015DQ780357), Sunshine Lake Pharma Co., Ltd, Dongguan, P. R. China
| | - Zhuangfeng Liu
- Department of Process Research and Development, HEC Pharm Group, Dongguan, P. R. China
| | - Yuting Liu
- Department of Process Research and Development, HEC Pharm Group, Dongguan, P. R. China
| | - Ting Hu
- Department of Process Research and Development, HEC Pharm Group, Dongguan, P. R. China
| | - Jiaxiang Sun
- Department of Process Research and Development, HEC Pharm Group, Dongguan, P. R. China
| | - Kunteng Wang
- Department of Process Research and Development, HEC Pharm Group, Dongguan, P. R. China
| | - Libo Xin
- Department of Process Research and Development, HEC Pharm Group, Dongguan, P. R. China
| | - Jinghui Cai
- Department of Process Research and Development, HEC Pharm Group, Dongguan, P. R. China
| | - Yanhua Li
- Department of Process Research and Development, HEC Pharm Group, Dongguan, P. R. China
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12
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Wang H, Wang H, Liu Y, Zhao J, Niu X, Zhu L, Ma X, Zong Y, Huang Y, Zhang W, Han Y. Efficacy and Safety of Five Broad-Spectrum Antiseizure Medications for Adjunctive Treatment of Refractory Epilepsy: A Systematic Review and Network Meta-analysis. CNS Drugs 2023; 37:883-913. [PMID: 37589821 DOI: 10.1007/s40263-023-01029-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Overall, up to one-third of epilepsy patients have drug-resistant epilepsy. However, there was previously no meta-analysis to support the guidelines for broad-spectrum antiseizure medication selection for the adjunctive treatment of refractory epilepsy. In the present meta-analysis, we assessed the efficacy and safety of three second-generation broad-spectrum antiseizure medications, lamotrigine (LTG), levetiracetam (LEV), and topiramate (TPM), and two third-generation broad-spectrum antiseizure medications, perampanel (PER) and lacosamide (LCM), for the adjunctive treatment of refractory epilepsy. METHODS We systematically searched PubMed, Embase, and CENTRAL from inception to July 15, 2022. The studies included in the meta-analysis were required to meet the following criteria: (1) be randomized, double-blind clinical trials; (2) include patients aged >2 years with a clinical diagnosis of drug-resistant epilepsy; (3) have at least 8 weeks for the treatment period excluding the titration phase; and (4) report the outcomes of seizure response, seizure freedom and the withdrawal rate due to treatment-emergent adverse effects. Data were extracted, and the risk of bias for each study was assessed by two authors independently using RoB2 tools. We performed the network meta-analysis for each outcome through a group of programs in the mvmeta and network packages in Stata. Relative odds ratios with 95% confidence intervals were calculated as the result of the analyses. The surface under the cumulative ranking curve (SUCRA) and mean ranks were used to rank these treatments. RESULTS Forty-two randomized controlled trials (RCTs) (LTG-placebo: n = 6, LEV-placebo: n = 13, TPM-placebo: n = 9, PER-placebo: n = 6, LCM-placebo: n = 7, LEV-TPM: n = 1) with 10257 participants (LTG = 569, LEV = 1626, TPM = 701, PER = 1734, LCM = 1908, placebo = 3719) were included. Levetiracetam had subequal efficacy in 50 % seizure frequency reduction to TPM [odds ratio (OR) 1.00, 95% confidence interval (CI) 0.73-1.38], and LEV had a higher rate of ≥ 50% seizure frequency reduction than LCM (OR 1.49, 95% CI 1.11-2.01) and PER (OR 1.68, 95% CI 1.24-2.29). Levetiracetam was also related to a higher proportion of seizure freedom participants than TPM (OR 1.87, 95% CI 1.20-2.89), PER (OR 2.23, 95% CI 1.12-4.43), and LCM (OR 2.97, 95% CI 1.46-6.05). In addition, LEV was associated with a lower risk of experiencing at least one treatment-emergent adverse event (TEAE) than PER (OR 0.63, 95% CI 0.46-0.85) and TPM (OR 0.51, 95 % CI 0.36-0.72) and a lower proportion of patients experiencing TEAEs leading to discontinuation than PER (OR 0.51, 95% CI 0.27-0.97) and TPM (OR 0.50, 95 % CI 0.27-0.93). CONCLUSIONS Third-generation drugs (PER and LCM) had no advantages in terms of efficacy and safety for adjunctive treatment of refractory epilepsy compared with several second-generation drugs (LEV and LTG). Levetiracetam was the priority choice for adjunctive treatment of refractory epilepsy. Perampanel and LCM had no advantages in terms of efficacy and safety among the five drugs. REGISTRATION PROSPERO registration number, CRD42022344153; last edited on December 23, 2022.
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Affiliation(s)
- Hecheng Wang
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, 124221, China
| | - Haoran Wang
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, 124221, China
| | - Yi Liu
- Department of Neurology, Dalian Municipal Central Hospital, Central Hospital of Dalian University of Technology, Dalian, China
| | - Jing Zhao
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, 124221, China
| | - Xuewen Niu
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, 124221, China
| | - Lei Zhu
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, 124221, China
| | - Xiaomin Ma
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, 124221, China
| | - Yu Zong
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, 124221, China
| | - Yinglin Huang
- Department of Psychiatry, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wei Zhang
- School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, 453003, China.
| | - Yanshuo Han
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, 124221, China.
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Halliday AJ, Vogrin S, Ignatiadis S, Gillinder L, Jones D, Kiley M, Kwan P, Seneviratne U, Somerville E, Whitham E. The efficacy and tolerability of adjunctive brivaracetam for the treatment of adult epilepsy: An Australian multi-center retrospective real-world observational cohort study. Epilepsy Behav 2023; 145:109287. [PMID: 37336131 DOI: 10.1016/j.yebeh.2023.109287] [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: 01/13/2023] [Revised: 05/25/2023] [Accepted: 05/25/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE Assess the efficacy and tolerability of add-on therapy brivaracetam (BRV) in adult patients with epilepsy in a real-world setting. METHODS This multi-center retrospective observational cohort study examined all adult patients who commenced on BRV at 11 Australian epilepsy centers between 2017 and 2020. Primary outcomes were seizure response (≥50% reduction in frequency) and seizure freedom 12 months post BRV commencement, and tolerability. We report three approaches to missing data (complete case analysis, CCA; last observation carried forward, LOCF; and intention to treat, ITT). Secondary outcomes included the durability of early BRV response and continuous seizure freedom from BRV initiation. Subgroup analysis examined patients with focal and generalized epilepsy and patients with refractory (≥4 prior ASMs) and highly refractory (≥7 prior ASMs) epilepsy. Outcomes were also assessed at 'personalized' seizure outcome time points based on baseline seizure frequency. RESULTS Baseline and follow-up data were available for 228 patients. The mean age was 41.5 years (IQR 30, 50). Most had focal epilepsy (188/228, 82.5%). Median number of previous ASMs was 4 (2, 7), and concomitant ASMs 2 (2, 3). Twelve-month responder rate was: 46.3% using CCA (95% CI 34.0, 58.9); 39.5% using LOCF (33.1, 46.1); and 15.4% using ITT (10.9, 20.7). Twelve-month seizure freedom was: 23.9% using CCA (14.3, 35.9); 24.6% using LOCF (19.1, 30.7); and 7.9% using ITT (4.7, 12.1). The most frequent adverse effects were sedation or cognitive slowing (33/228, 14.5%), irritability or aggression (16/228, 7.0%), and low mood (14/228, 6.1%). Outcomes were similar using continuous outcome definitions and 'personalized' outcome assessment time points. Early responses were highly durable, with 3-month response maintained at all subsequent time points at 83%, and seizure freedom maintained at 85%. Outcomes were similar in focal (n = 187) and generalizsed (n = 25) subgroups. Outcomes were similar in refractory patients (n = 129), but lower in the highly refractory group (n = 62), however improvement with BRV was still observed with 12-month seizure freedom of 8.3% using CCA (1.0, 27), 6.5% using LOCF (1.8, 15.7); and 3.2% using ITT (0.4, 11.2). CONCLUSIONS Meaningful real-world responder and seizure freedom rates can be still observed in a refractory epilepsy population. Brivaracetam response can occur early and appears to be maintained with minimal later relapse. The results should be interpreted with caution given the retrospective nature of the study and the quantities of missing data at later time points.
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Affiliation(s)
- Amy J Halliday
- Department of Clinical Neurosciences, St Vincent's Hospital Melbourne, Melbourne, Australia; Department of Medicine, St. Vincents Hospital Melbourne, University of Melbourne, Melbourne, Australia.
| | - Sara Vogrin
- Department of Medicine, St. Vincents Hospital Melbourne, University of Melbourne, Melbourne, Australia.
| | - Sophia Ignatiadis
- Department of Clinical Neurosciences, St Vincent's Hospital Melbourne, Melbourne, Australia; Department of Medicine, St. Vincents Hospital Melbourne, University of Melbourne, Melbourne, Australia.
| | - Lisa Gillinder
- Mater Centre for Neurosciences, Mater Hospital Brisbane, South Brisbane, Queensland, Australia; Neurology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Dean Jones
- Department of Neurology, Royal Hobart Hospital, 48 Liverpool Street, Hobart, Tasmania, Australia; Tasmanian School of Medicine, University of Tasmania, Churchill Ave, Hobart Tasmania 7005, Australia.
| | - Michelle Kiley
- Department of Neurology, Royal Adelaide Hospital, Australia.
| | - Patrick Kwan
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia; Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, 99 Commercial Road, Melbourne 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne 3004, Australia.
| | - Udaya Seneviratne
- Department of Neurology, Monash Medical Centre, Melbourne, Australia.
| | - Ernest Somerville
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia; Comprehensive Epilepsy Service, Prince of Wales Hospital, Sydney, NSW, Australia.
| | - Emma Whitham
- Department of Neurology, Flinders Medical Centre, Australia.
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14
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Mavri A, Ilc S. The efficacy of direct oral anticoagulants in patients on concomitant treatment with levetiracetam. Sci Rep 2023; 13:9257. [PMID: 37286616 DOI: 10.1038/s41598-023-33876-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 04/20/2023] [Indexed: 06/09/2023] Open
Abstract
Guidelines do not support the combination of direct oral anticoagulants (DOACs) and the antiepileptic drug levetiracetam, due to potential relevant P-glycoprotein (P-gp) mediated interaction that might result in decreased DOACs concentrations and increased thromboembolic risk. However, there is no systematic data on the safety of this combination. The aim of this study was to find patients concurrently treated with levetiracetam and DOAC, assess their plasma concentrations of DOAC, and the incidence of thromboembolic events. From our registry of patients on anticoagulation drugs we identified 21 patients concomitantly treated with levetiracetam and DOAC, 19 patients with atrial fibrillation and two patients with venous thromboembolism. Eight patients received dabigatran, 9 apixaban and 4 rivaroxaban. For each subject blood samples were collected for determination of trough DOAC and trough levetiracetam concentrations. The average age was 75 ± 9 years, 84% were males, HAS-BLED score was 1.8 ± 0.8, and in patients with atrial fibrillation CHA2DS2-VASc score was 4.6 ± 2.0. The average trough concentration level of levetiracetam was 31.0 ± 34.5 mg/L. Median trough concentrations of DOACs were for dabigatran 72 (range 25-386) ng/mL, for rivaroxaban 47 (range 19-75) ng/mL, and for apixaban 139 (range 36-302) ng/mL. During the observation period of 1388 ± 994 days none of the patients suffered a thromboembolic event. Our results did not demonstrate a reduction in DOACs plasma levels during levetiracetam treatment, suggesting that levetiracetam could not be an important P-gp inducer in humans. DOAC in combination with levetiracetam remained effective therapy to protect against thromboembolic events.
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Affiliation(s)
- Alenka Mavri
- Department of Vascular Diseases, University Medical Centre Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia.
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - Sara Ilc
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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15
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Koekkoek JAF, van der Meer PB, Pace A, Hertler C, Harrison R, Leeper HE, Forst DA, Jalali R, Oliver K, Philip J, Taphoorn MJB, Dirven L, Walbert T. Palliative care and end-of-life care in adults with malignant brain tumors. Neuro Oncol 2023; 25:447-456. [PMID: 36271873 PMCID: PMC10013651 DOI: 10.1093/neuonc/noac216] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND This systematic review provides updated insights, from the published literature in the past 5 years, based on the 2017 European Association of Neuro-Oncology (EANO) guidelines for palliative care in adults with malignant brain tumors. It provides an overview of palliative care options, including during the end-of-life phase for patients with malignant brain tumors. METHODS A systematic literature search was conducted from 2016 to 2021 focusing on four main topics: (1) symptom management, (2) caregiver needs, (3) early palliative care, and (4) care in the end-of-life phase. An international panel of palliative care experts in neuro-oncology synthesized the literature and reported the most relevant updates. A total of 140 articles were included. RESULTS New insights include that: Hippocampal avoidance and stereotactic radiosurgery results in a lower risk of neurocognitive decline in patients with brain metastases; levetiracetam is more efficacious in reducing seizures than valproic acid as first-line monotherapy antiseizure drug (ASD) in glioma patients; lacosamide and perampanel seem well-tolerated and efficacious add-on ASDs; and a comprehensive framework of palliative and supportive care for high-grade glioma patients and their caregivers was proposed. No pharmacological agents have been shown in randomized controlled trials to significantly improve fatigue or neurocognition. CONCLUSIONS Since the 2017 EANO palliative care guidelines, new insights have been reported regarding symptom management and end-of-life care, however, most recommendations remain unchanged. Early palliative care interventions are essential to define goals of care and minimize symptom burden in a timely fashion. Interventional studies that address pain, fatigue, and psychiatric symptoms as well as (the timing of) early palliative care are urgently needed.
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Affiliation(s)
- Johan A F Koekkoek
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Pim B van der Meer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrea Pace
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Caroline Hertler
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Rebecca Harrison
- Division of Medical Oncology, BC Cancer, The University of British Colombia, Vancouver, Canada
| | - Heather E Leeper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland,USA
| | - Deborah A Forst
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Rakesh Jalali
- Department of Radiation Oncology, Apollo Proton Cancer Center, Chennai, India
| | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, UK
| | - Jennifer Philip
- Department of Medicine, St. Vincent’s Hospital Melbourne, University of Melbourne, Victoria, Australia
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Tobias Walbert
- Department of Neurology and Neurosurgery, Henry Ford Health System and Department of Neurology Wayne State University, Detroit, Michigan, USA
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16
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Evaluation of the Antioxidant Activity of Levetiracetam in a Temporal Lobe Epilepsy Model. Biomedicines 2023; 11:biomedicines11030848. [PMID: 36979827 PMCID: PMC10045287 DOI: 10.3390/biomedicines11030848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/14/2023] Open
Abstract
Epilepsy is a neurological disorder in which it has been shown that the presence of oxidative stress (OS) is implicated in epileptogenesis. The literature has shown that some antiseizure drugs (ASD) have neuroprotective properties. Levetiracetam (LEV) is a drug commonly used as an ASD, and in some studies, it has been found to possess antioxidant properties. Because the antioxidant effects of LEV have not been demonstrated in the chronic phase of epilepsy, the objective of this study was to evaluate, for the first time, the effects of LEV on the oxidant–antioxidant status in the hippocampus of rats with temporal lobe epilepsy (TLE). The in vitro scavenging capacity of LEV was evaluated. LEV administration in rats with TLE significantly increased superoxide dismutase (SOD) activity, increased catalase (CAT) activity, but did not change glutathione peroxidase (GPx) activity, and significantly decreased glutathione reductase (GR) activity in comparison with epileptic rats. LEV administration in rats with TLE significantly reduced hydrogen peroxide (H2O2) levels but did not change lipoperoxidation and carbonylated protein levels in comparison with epileptic rats. In addition, LEV showed in vitro scavenging activity against hydroxyl radical (HO•). LEV showed significant antioxidant effects in relation to restoring the redox balance in the hippocampus of rats with TLE. In vitro, LEV demonstrated direct antioxidant activity against HO•.
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17
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Besag FMC, Vasey MJ, Sen A. Current evidence for adjunct pyridoxine (vitamin B6) for the treatment of behavioral adverse effects associated with levetiracetam: A systematic review. Epilepsy Behav 2023; 140:109065. [PMID: 36791631 DOI: 10.1016/j.yebeh.2022.109065] [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: 08/02/2022] [Revised: 12/17/2022] [Accepted: 12/17/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND Levetiracetam (LVT), while an effective treatment for multiple seizure types, is associated with a high incidence of neuropsychiatric adverse events (NPAEs). In predominantly retrospective studies, supplementation with pyridoxine/vitamin B6 (PN) was associated with improvement in NPAEs in some people. A previous review highlighted a lack of double-blind, controlled trials of PN for the treatment of NPAEs in individuals treated with LVT. The current paper updates the findings from the previous review to include evidence from studies published since June 2019. METHODS An updated systematic review of the published literature was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, the Cochrane Library, and Google Scholar were searched to identify studies published between June 2019 and 2nd November 2022 in which supplementary PN was initiated for the treatment of LVT-associated NPAEs. All study types were eligible. The risk of bias in randomized trials was assessed using the Cochrane risk-of-bias tool. RESULTS Seven additional studies were identified: two double-blind, randomized controlled trials (RCTs), four retrospective studies, and one retrospective case series. One RCT reported significant improvements from baseline in behavioral adverse events (BAEs) in both the intervention (PN) group and the low-dose control group (both p < 0.05), with a significantly greater improvement in the intervention group (p < 0.001). In the second RCT, differences in BAE severity between PN and placebo groups at the endpoint were not statistically significant. In one retrospective study, subjective irritability was reported to have improved from baseline in 9/20 individuals (45%) treated with supplementary PN. Data for systematic assessments (PHQ-9 and GAD-7) were available for 10 individuals. Assessment by PHQ-9 showed that six individuals improved, two worsened and two had no change. Based on the GAD-7, three people improved, two worsened and five had no change. In the second retrospective study, 18/41 individuals (44%) who commenced PN following the emergence of BAEs showed "significant" improvement. In a separate group of individuals with pre-existing behavioral problems in whom PN treatment was initiated at the same time as commencing LVT, 3/18 (16.7%) developed BAEs. This compared with 79/458 people (17.2%) who were initially treated only with LVT. The third retrospective study compared treatment-related irritability in individuals who had been treated with both LVT and perampanel, either sequentially or concomitantly. Two people who developed irritability while receiving LVT monotherapy were able to continue treatment with the addition of PN. The fourth study reported a significantly lower LVT discontinuation rate in individuals taking PN and a higher rate of improved behavior in those who were able to continue LVT. The case series reported improvements in behavioral symptoms in six people within two to three weeks of commencing supplementary PN. CONCLUSION Data published within the last three years add to earlier evidence suggesting that PN might be effective in the treatment of NPAEs associated with LVT. However, the quality of evidence remains poor and only a few prospective trials have been published. Data from placebo-controlled trials are still largely lacking. Currently, there is insufficient evidence to justify any firm recommendation for PN supplementation to treat NPAEs associated with LVT. Further well-designed, prospective trials are warranted.
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Affiliation(s)
- Frank M C Besag
- Child and Adolescent Mental Health Services, East London NHS Foundation Trust, Bedford, UK; School of Pharmacy, University College London, London, UK; Department of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | | | - Arjune Sen
- Oxford Epilepsy Research Group, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
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18
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Samudra N, Ranasinghe K, Kirsch H, Rankin K, Miller B. Etiology and Clinical Significance of Network Hyperexcitability in Alzheimer's Disease: Unanswered Questions and Next Steps. J Alzheimers Dis 2023; 92:13-27. [PMID: 36710680 DOI: 10.3233/jad-220983] [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] [Indexed: 01/25/2023]
Abstract
Cortical network hyperexcitability related to synaptic dysfunction in Alzheimer's disease (AD) is a potential target for therapeutic intervention. In recent years, there has been increased interest in the prevalence of silent seizures and interictal epileptiform discharges (IEDs, or seizure tendency), with both entities collectively termed "subclinical epileptiform activity" (SEA), on neurophysiologic studies in AD patients. SEA has been demonstrated to be common in AD, with prevalence estimates ranging between 22-54%. Converging lines of basic and clinical evidence imply that modifying a hyperexcitable state results in an improvement in cognition. In particular, though these results require further confirmation, post-hoc findings from a recent phase II clinical trial suggest a therapeutic effect with levetiracetam administration in patients with AD and IEDs. Here, we review key unanswered questions as well as potential clinical trial avenues. Specifically, we discuss postulated mechanisms and treatment of hyperexcitability in patients with AD, which are of interest in designing future disease-modifying therapies. Criteria to prompt screening and optimal screening methodology for hyperexcitability have yet to be defined, as does timing and personalization of therapeutic intervention.
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Affiliation(s)
- Niyatee Samudra
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Kamalini Ranasinghe
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Heidi Kirsch
- University of California, San Francisco Comprehensive Epilepsy Center, San Francisco, CA, USA
| | - Katherine Rankin
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Bruce Miller
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
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19
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Mensah JA, Johnson K, Reilly CA, Wilcox KS, Rower JE, Metcalf CS. Evaluating the efficacy of prototype antiseizure drugs using a preclinical pharmacokinetic approach. Epilepsia 2022; 63:2937-2948. [PMID: 36054499 PMCID: PMC9669179 DOI: 10.1111/epi.17402] [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: 07/11/2022] [Revised: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Pharmacokinetics (PK) of a drug drive its exposure, efficacy, and tolerability. A thorough preclinical PK assessment of antiseizure medications (ASMs) is therefore essential to evaluate the clinical potential. We tested protection against evoked seizures of prototype ASMs in conjunction with analysis of plasma and brain PK as a proof-of-principle study to enhance our understanding of drug efficacy and duration of action using rodent seizure models. METHODS In vivo seizure protection assays were performed in adult male CF-1 mice and Sprague Dawley rats. Clobazam (CLB), N-desmethyl CLB (NCLB), carbamazepine (CBZ), CBZ-10,11-epoxide (CBZE), sodium valproate (VPA), and levetiracetam (LEV) concentrations were quantified in plasma and brain using liquid chromatography-tandem mass spectrometry. Mean concentrations of each analyte were calculated and used to determine PK parameters via noncompartmental analysis in Phoenix WinNonLin. RESULTS NCLB concentrations were approximately 10-fold greater than CLB in mice. The antiseizure profile of CLB was partially sustained by NCLB in mice. CLB concentrations were lower in rats than in mice. CBZE plasma exposures were approximately 70% of CBZ in both mice and rats, likely contributing to the antiseizure effect of CBZ. VPA showed a relatively short half-life in both mice and rats, which correlated with a sharp decline in efficacy. LEV had a prolonged brain and plasma half-life, associated with a prolonged duration of action in mice. SIGNIFICANCE The study demonstrates the utility of PK analyses for understanding the seizure protection time course in mice and rats. The data indicate that distinct PK profiles of ASMs between mice and rats likely drive differences in drug efficacy between rodent models.
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Affiliation(s)
- Jeffrey A. Mensah
- Department of Pharmacology & Toxicology, University of Utah, Salt Lake City, UT, USA
| | - Kristina Johnson
- Epilepsy Therapy Screening Program (ETSP) Contract Site, University of Utah, Salt Lake, UT, USA
| | - Christopher A. Reilly
- Department of Pharmacology & Toxicology, University of Utah, Salt Lake City, UT, USA
- Center for Human Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Karen S. Wilcox
- Epilepsy Therapy Screening Program (ETSP) Contract Site, University of Utah, Salt Lake, UT, USA
- Department of Pharmacology & Toxicology, University of Utah, Salt Lake City, UT, USA
| | - Joseph E. Rower
- Department of Pharmacology & Toxicology, University of Utah, Salt Lake City, UT, USA
- Center for Human Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Cameron S. Metcalf
- Epilepsy Therapy Screening Program (ETSP) Contract Site, University of Utah, Salt Lake, UT, USA
- Department of Pharmacology & Toxicology, University of Utah, Salt Lake City, UT, USA
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20
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Sato H, Takase K, Harada A, Ozono I, Kodama Y, Ishitobi T, Imada T, Ohnuma H, Kin S. Atypical, Levetiracetam-induced Hypersensitivity Syndrome Complicated by Fulminant Liver Failure in a Patient Undergoing Hemodialysis. Intern Med 2022; 61:2911-2916. [PMID: 35228427 PMCID: PMC9593156 DOI: 10.2169/internalmedicine.8985-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
A 59-year-old man undergoing hemodialysis was administered levetiracetam, after which he developed a systemic rash, high fever, severe liver dysfunction, and leukocytopenia with reactivation of human herpes virus 6. Atypical drug-induced hypersensitivity (DIHS) was diagnosed, and prednisolone was administered at 60 mg/day. However, liver failure rapidly progressed, and the patient died 12 days following treatment. Despite the rarity of DIHS with concomitant fulminant liver failure from levetiracetam and sufficient clearance thereof by hemodialysis, our case suggests that this syndrome may still ensue, resulting in mortality, even in hemodialysis patients. Although no treatment has yet been established, strict monitoring and aggressive treatment may be required.
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Affiliation(s)
- Hirotaka Sato
- Department of Nephrology, Shimane Prefectural Central Hospital, Japan
| | - Kentaro Takase
- Department of Nephrology, Shimane Prefectural Central Hospital, Japan
| | - Aiko Harada
- Department of General Medicine, Shimane Prefectural Central Hospital, Japan
| | - Iori Ozono
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Japan
| | - Yasuhide Kodama
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Japan
| | - Tomoko Ishitobi
- Department of Dermatology, Shimane Prefectural Central Hospital, Japan
| | - Toshihiro Imada
- Department of General Medicine, Shimane Prefectural Central Hospital, Japan
| | - Hideyuki Ohnuma
- Department of Pathology, Shimane Prefectural Central Hospital, Japan
| | - Seikon Kin
- Department of Nephrology, Shimane Prefectural Central Hospital, Japan
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21
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Yang H, Yang L, Zhong X, Jiang X, Zheng L, Wang L. Physiologically based pharmacokinetic modeling of brivaracetam and its interactions with rifampin based on CYP2C19 phenotypes. Eur J Pharm Sci 2022; 177:106258. [PMID: 35840101 DOI: 10.1016/j.ejps.2022.106258] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/09/2022] [Accepted: 07/11/2022] [Indexed: 11/03/2022]
Abstract
Brivaracetam (BRV), a third-generation antiepileptic drug (AED), is primarily metabolized through amidase hydrolysis and CYP2C19-mediated hydroxylation in vivo. This study utilized physiologically based pharmacokinetic (PBPK) modeling to explore the pharmacokinetics of BRV and drug interactions between BRV and rifampin (RIF), a CYP2C19 inducer, based on CYP2C19 genetic polymorphisms. A PBPK model of BRV was developed in the general population and in individuals with different CYP2C19 phenotypes by adjusting catalytic rate constants (kcat), and the model was validated with observed clinical data. The model was then extrapolated to predict BRV steady-state plasma concentration in individuals with different CYP2C19 phenotypes, with or without coadministration of RIF. The developed model adequately described BRV exposure in the abovementioned populations. The predicted steady-state area under the curve (AUCτ-ss) increases by 20% in heterozygous extensive metabolizers (hEMs) and 55% in poor metabolizers (PMs), compared to homozygous extensive metabolizer (EMs). When coadministered with RIF, the model predicted the most significant magnitude of drug-drug interaction (DDI) in EMs, while the exposure change of BRV was minimal in PMs. Referencing the recommended concentration for therapeutic drug monitoring (TDM), we concluded that the current clinical maintenance dose of BRV is acceptable regardless of CYP2C19 polymorphisms and coadministration with RIF.
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Affiliation(s)
- Hongyi Yang
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry, Department of Clinical Pharmacy and Pharmacy Administration, West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Leting Yang
- Chengdu Gencore Pharmaceutical Technology Co., Ltd., Chengdu, China
| | - Xiaofang Zhong
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry, Department of Clinical Pharmacy and Pharmacy Administration, West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Xuehua Jiang
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry, Department of Clinical Pharmacy and Pharmacy Administration, West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Liang Zheng
- Department of Clinical Pharmacology, The Second Hospital of Anhui Medical University, Hefei, China.
| | - Ling Wang
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry, Department of Clinical Pharmacy and Pharmacy Administration, West China School of Pharmacy, Sichuan University, Chengdu, China.
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22
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Zhu H, Deng X, Feng L, Lian Y, Han X, Guo Z, Gou Y, Du Y, Xie L, Yao D, Liu Y, Wu Q, Lan S, Liu K, Zhan P, Wang X, Dang J, Hou Y, Chen K, Zhu Y, Shi Y, Yu Y, Xiao B, Zhu S, Meng H. Efficacy comparison of oxcarbazepine and levetiracetam monotherapy among patients with newly diagnosed focal epilepsy in China: A multicenter, open-label, randomized study. CNS Neurosci Ther 2022; 28:1072-1080. [PMID: 35429132 PMCID: PMC9160445 DOI: 10.1111/cns.13840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 03/08/2022] [Accepted: 03/25/2022] [Indexed: 11/30/2022] Open
Abstract
Aims This multicenter, open‐label, randomized study (Registration No. ChiCTR‐OCH‐14004528) aimed to compare the efficacy and effects of oxcarbazepine (OXC) with levetiracetam (LEV) as monotherapies on patient quality of life and mental health for patients with newly diagnosed focal epilepsy from China. Methods Patients with newly diagnosed focal epilepsy who had experienced 2 or more unprovoked seizures at greater than a 24‐h interval during the previous year were recruited. Participants were randomly assigned to the OXC group or LEV group. Efficacy, safety, quality of life, and mental health were evaluated over 12‐week and 24‐week periods. Results In total, we recruited 271 newly diagnosed patients from 23 centers. Forty‐four patients were excluded before treatment for reasons. The rate of seizure freedom of OXC was significantly superior to that of LEV at 12 weeks and 24 weeks (p < 0.05). The quality of life (except for the seizure worry subsection) and anxiety scale scores also showed significant differences from before to after treatment in the OXC and LEV groups. Conclusions OXC monotherapy may be more effective than LEV monotherapy in patients with newly diagnosed focal epilepsy. Both OXC and LEV could improve the quality of life and anxiety state in adult patients with focal epilepsy.
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Affiliation(s)
- Haoyue Zhu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xuejun Deng
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yajun Lian
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiong Han
- Department of Neurology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Zhenli Guo
- Department of Neurology, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan, China
| | - Yulan Gou
- Department of Neurology, Wuhan No. 1 Hospital, Wuhan, China
| | - Yuanmin Du
- Department of Neurology, Wuhan General Hospital of the YANGTZE River Shipping, Wuhan, China
| | - Longshan Xie
- Department of Functional Neuroscience, The First People's Hospital of Foshan, Foshan, China
| | - Dongai Yao
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yonghong Liu
- Department of Neurology, Xijing Hospital of Air Force Military Medical University, Xi'an, China
| | - Qiang Wu
- Department of Neurology, Wuhan General Hospital of PLA, Wuhan, China
| | - Song Lan
- Department of Internal Medicine-Neurology, Maoming People's Hospital of Guangdong Province, Maoming, China
| | - Kaisheng Liu
- Department of Neurology, Taihe Hospital, Shiyan, China
| | - Peiyan Zhan
- Department of Neurology, The Central Hospital of Wuhan, Wuhan, China
| | - Xiahong Wang
- Department of Neurology, Zhengzhou Second Hospital, Zhengzhou, China
| | - Jingxia Dang
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yunqi Hou
- Department of Neurology, Shunde First Affiliated Hospital of Southern Medical University, Shunde, China
| | - Keqiang Chen
- Department of Neurology, Central Hospital of Jiangmen, Jiangmen, China
| | - Yulan Zhu
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yuliang Shi
- Department of Neurology, People's Hospital of Meizhou, Meizhou, China
| | - Yunli Yu
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Suiqiang Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongmei Meng
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
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23
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Zhang Y, Heylen L, Partoens M, Mills JD, Kaminski RM, Godard P, Gillard M, de Witte PAM, Siekierska A. Connectivity Mapping Using a Novel sv2a Loss-of-Function Zebrafish Epilepsy Model as a Powerful Strategy for Anti-epileptic Drug Discovery. Front Mol Neurosci 2022; 15:881933. [PMID: 35686059 PMCID: PMC9172968 DOI: 10.3389/fnmol.2022.881933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/08/2022] [Indexed: 12/03/2022] Open
Abstract
Synaptic vesicle glycoprotein 2A (SV2A) regulates action potential-dependent neurotransmitter release and is commonly known as the primary binding site of an approved anti-epileptic drug, levetiracetam. Although several rodent knockout models have demonstrated the importance of SV2A for functional neurotransmission, its precise physiological function and role in epilepsy pathophysiology remains to be elucidated. Here, we present a novel sv2a knockout model in zebrafish, a vertebrate with complementary advantages to rodents. We demonstrated that 6 days post fertilization homozygous sv2a–/– mutant zebrafish larvae, but not sv2a+/– and sv2a+/+ larvae, displayed locomotor hyperactivity and spontaneous epileptiform discharges, however, no major brain malformations could be observed. A partial rescue of this epileptiform brain activity could be observed after treatment with two commonly used anti-epileptic drugs, valproic acid and, surprisingly, levetiracetam. This observation indicated that additional targets, besides Sv2a, maybe are involved in the protective effects of levetiracetam against epileptic seizures. Furthermore, a transcriptome analysis provided insights into the neuropathological processes underlying the observed epileptic phenotype. While gene expression profiling revealed only one differentially expressed gene (DEG) between wildtype and sv2a+/– larvae, there were 4386 and 3535 DEGs between wildtype and sv2a–/–, and sv2a+/– and sv2a–/– larvae, respectively. Pathway and gene ontology (GO) enrichment analysis between wildtype and sv2a–/– larvae revealed several pathways and GO terms enriched amongst up- and down-regulated genes, including MAPK signaling, synaptic vesicle cycle, and extracellular matrix organization, all known to be involved in epileptogenesis and epilepsy. Importantly, we used the Connectivity map database to identify compounds with opposing gene signatures compared to the one observed in sv2a–/– larvae, to finally rescue the epileptic phenotype. Two out of three selected compounds rescued electrographic discharges in sv2a–/– larvae, while negative controls did not. Taken together, our results demonstrate that sv2a deficiency leads to increased seizure vulnerability and provide valuable insight into the functional importance of sv2a in the brain in general. Furthermore, we provided evidence that the concept of connectivity mapping represents an attractive and powerful approach in the discovery of novel compounds against epilepsy.
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Affiliation(s)
- Yifan Zhang
- Laboratory for Molecular Biodiscovery, KU Leuven, Leuven, Belgium
| | - Lise Heylen
- Laboratory for Molecular Biodiscovery, KU Leuven, Leuven, Belgium
| | - Michèle Partoens
- Laboratory for Molecular Biodiscovery, KU Leuven, Leuven, Belgium
| | - James D. Mills
- Department of Neuropathology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
| | - Rafal M. Kaminski
- Department of Medicinal Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
- UCB Pharma, Braine-l’Alleud, Belgium
| | | | | | - Peter A. M. de Witte
- Laboratory for Molecular Biodiscovery, KU Leuven, Leuven, Belgium
- *Correspondence: Peter A. M. de Witte,
| | - Aleksandra Siekierska
- Laboratory for Molecular Biodiscovery, KU Leuven, Leuven, Belgium
- Aleksandra Siekierska,
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24
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Özbek O, Berkel C, Isildak Ö, Gürdere MB. HPLC–based methods for the determination of levetiracetam in biological and pharmaceutical samples. J INDIAN CHEM SOC 2022. [DOI: 10.1016/j.jics.2022.100348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Contreras-García IJ, Cárdenas-Rodríguez N, Romo-Mancillas A, Bandala C, Zamudio SR, Gómez-Manzo S, Hernández-Ochoa B, Mendoza-Torreblanca JG, Pichardo-Macías LA. Levetiracetam Mechanisms of Action: From Molecules to Systems. Pharmaceuticals (Basel) 2022; 15:ph15040475. [PMID: 35455472 PMCID: PMC9030752 DOI: 10.3390/ph15040475] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022] Open
Abstract
Epilepsy is a chronic disease that affects millions of people worldwide. Antiepileptic drugs (AEDs) are used to control seizures. Even though parts of their mechanisms of action are known, there are still components that need to be studied. Therefore, the search for novel drugs, new molecular targets, and a better understanding of the mechanisms of action of existing drugs is still crucial. Levetiracetam (LEV) is an AED that has been shown to be effective in seizure control and is well-tolerable, with a novel mechanism of action through an interaction with the synaptic vesicle protein 2A (SV2A). Moreover, LEV has other molecular targets that involve calcium homeostasis, the GABAergic system, and AMPA receptors among others, that might be integrated into a single mechanism of action that could explain the antiepileptogenic, anti-inflammatory, neuroprotective, and antioxidant properties of LEV. This puts it as a possible multitarget drug with clinical applications other than for epilepsy. According to the above, the objective of this work was to carry out a comprehensive and integrative review of LEV in relation to its clinical uses, structural properties, therapeutical targets, and different molecular, genetic, and systemic action mechanisms in order to consider LEV as a candidate for drug repurposing.
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Affiliation(s)
| | - Noemí Cárdenas-Rodríguez
- Laboratorio de Neurociencias, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Ciudad de México 04530, Mexico;
| | - Antonio Romo-Mancillas
- Laboratorio de Diseño Asistido por Computadora y Síntesis de Fármacos, Facultad de Química, Universidad Autónoma de Querétaro, Centro Universitario, Querétaro 76010, Mexico;
| | - Cindy Bandala
- Neurociencia Básica, Instituto Nacional de Rehabilitación LGII, Secretaría de Salud, Ciudad de México 14389, Mexico;
- Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México 11340, Mexico
| | - Sergio R. Zamudio
- Departamento de Fisiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México 07738, Mexico;
| | - Saúl Gómez-Manzo
- Laboratorio de Bioquímica Genética, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de México 04530, Mexico;
| | - Beatriz Hernández-Ochoa
- Laboratorio de Inmunoquímica, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Ciudad de México 06720, Mexico;
| | - Julieta Griselda Mendoza-Torreblanca
- Laboratorio de Neurociencias, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Ciudad de México 04530, Mexico;
- Correspondence: (J.G.M.-T.); (L.A.P.-M.); Tel.: +52-55-1084-0900 (ext. 1441) (J.G.M.-T.)
| | - Luz Adriana Pichardo-Macías
- Departamento de Fisiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México 07738, Mexico;
- Correspondence: (J.G.M.-T.); (L.A.P.-M.); Tel.: +52-55-1084-0900 (ext. 1441) (J.G.M.-T.)
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26
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Lee K, Klein P, Dongre P, Choi EJ, Rhoney DH. Intravenous Brivaracetam in the Management of Acute Seizures in the Hospital Setting: A Scoping Review. J Intensive Care Med 2022; 37:1133-1145. [PMID: 35306914 PMCID: PMC9393655 DOI: 10.1177/08850666211073598] [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] [Indexed: 11/24/2022]
Abstract
Background Clinical considerations for drug treatment of acute seizures involve
variables such as safety, tolerability, drug-drug interactions, dosage,
route of administration, and alterations in pharmacokinetics because of
critical illness. Therapy options that are easily and quickly administered
without dilution, well tolerated, and effective are needed for the treatment
of acute seizures. The objective of this review is to focus on the clinical
considerations relating to the use of intravenous brivaracetam (IV BRV) for
the treatment of acute seizures in the hospital, focusing on critically ill
patients. Methods This was a scoping literature review of PubMed from inception to April 13,
2021, and search of the American Academy of Neurology (AAN) 2021 Annual
Meeting website for English language publications/conference abstracts
reporting the results of IV BRV use in hospitalized patients, particularly
in the critical care setting. Outcomes of interest relating to the clinical
pharmacology, safety, tolerability, efficacy, and effectiveness of IV BRV
were reviewed and are discussed. Results Twelve studies were included for analysis. One study showed that plasma
concentrations of IV BRV 15 min after the first dose were similar between
patients receiving IV BRV as bolus or infusion. IV BRV was generally well
tolerated in patients with acute seizures in the hospital setting, with a
low incidence of individual TEAEs classified as behavioral disorders. IV BRV
demonstrated efficacy and effectiveness and had a rapid onset, with clinical
and electrophysiological improvement in seizures observed within minutes.
Although outside of the approved label, findings from several studies
suggest that IV BRV reduces seizures and is generally well tolerated in
patients with status epilepticus. Conclusions IV BRV shows effectiveness, and is generally well tolerated in the management
of acute seizures in hospitalized patients where rapid administration is
needed, representing a clinically relevant antiseizure medication for
potential use in the critical care setting.
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Affiliation(s)
- Kiwon Lee
- Department of Neurology, Division of Stroke and Critical Care, Rutgers, The State University of New Jersey, 12287Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA
| | | | | | - Denise H Rhoney
- 15521UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, NC, USA
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27
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Strasser B, Tomasits J. Crossreactivity in antiepileptic drug monitoring: Reply to: Real-life experience with brivaracetam in 101 patients with difficult-to-treat epilepsy-a monocenter survey. Seizure 2021; 94:115-116. [PMID: 34894439 DOI: 10.1016/j.seizure.2021.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 11/28/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Bernhard Strasser
- Institute of Laboratory Medicine, Kepler University Hospital Linz, Krankenhausstraße 26-30, Linz 4020, Austria.
| | - Josef Tomasits
- Institute of Laboratory Medicine, Kepler University Hospital Linz, Krankenhausstraße 26-30, Linz 4020, Austria
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28
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Alavi MS, Negah SS, Ghorbani A, Hosseini A, Sadeghnia HR. Levetiracetam promoted rat embryonic neurogenesis via NMDA receptor-mediated mechanism in vitro. Life Sci 2021; 284:119923. [PMID: 34481865 DOI: 10.1016/j.lfs.2021.119923] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
AIMS Levetiracetam (LEV) is a broad-spectrum antiepileptic drug with neuroprotective properties and novel mechanisms of action. Some evidence suggests that LEV may impact adult neurogenesis, but the results are controversial. The present study was aimed to evaluate the effects of LEV on the proliferation and differentiation of rat embryonic neural stem cells (NSCs) and to explore the role of GABAB or NMDA receptors. MAIN METHODS NSCs were isolated from rat fetal ganglionic eminence at embryonic day 14.5. The effects of LEV on viability, proliferation, neurosphere formation, and neuronal or astroglial differentiation of NSCs were assessed using resazurin, BrdU incorporation, immunocytochemistry, quantitative real-time PCR, and western blotting. Additionally, we addressed the relationship between treatment with NMDA and GABAB receptor antagonists (MK801 and saclofen, respectively) in combination with LEV on these parameters. KEY FINDINGS The data showed that LEV (50 μM) significantly increased the number (p < 0.01) and diameter of neurospheres (p < 0.05), enhanced proliferation (p < 0.01), and promoted neuronal differentiation, as revealed by significantly increased expressions of DCX and NeuN. The expressions of astroglial markers, GFAP and Olig2, were markedly reduced. The addition of MK801 (10 μM) significantly diminished neurospheres growth (p < 0.001), decreased the number of proliferating cells (p < 0.01), and reduced the number of new neurons (p < 0.001) but increased the astroglial cells (p < 0.001) induced by LEV. Co-treatment with saclofen (25 μM) did not significantly affect LEV-induced NSCs proliferation and differentiation. SIGNIFICANCE Our findings suggest that LEV may enhance rat embryonic neurogenesis mainly through an NMDA receptor-mediated mechanism.
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Affiliation(s)
- Mohaddeseh Sadat Alavi
- Department of Pharmacology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Division of Neurocognitive Sciences, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sajad Sahab Negah
- Neuroscience Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ahmad Ghorbani
- Department of Pharmacology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Azar Hosseini
- Department of Pharmacology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid R Sadeghnia
- Department of Pharmacology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Division of Neurocognitive Sciences, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran.
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Eastman CL, Fender JS, Klein P, D'Ambrosio R. Therapeutic Effects of Time-Limited Treatment with Brivaracetam on Posttraumatic Epilepsy after Fluid Percussion Injury in the Rat. J Pharmacol Exp Ther 2021; 379:310-323. [PMID: 34593559 DOI: 10.1124/jpet.121.000585] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 09/28/2021] [Indexed: 11/22/2022] Open
Abstract
Mounting evidence suggests the synaptic vesicle glycoprotein 2A (SV2A) targeted by levetiracetam may contribute to epileptogenesis. Levetiracetam has shown anti-inflammatory, antioxidant, neuroprotective, and possible antiepileptogenic effects in brain injury and seizure/epilepsy models, and a phase 2 study has signaled a possible clinical antiepileptogenic effect. Brivaracetam shows greater affinity and specificity for SV2A than levetiracetam and broader preclinical antiseizure effects. Thus, we assessed the antiepileptogenic/disease-modifying potential of brivaracetam in an etiologically realistic rat posttraumatic epilepsy model optimized for efficient drug testing. Brivaracetam delivery protocols were designed to maintain clinical moderate-to-high plasma levels in young (5-week-old) male Sprague-Dawley rats for 4 weeks. Treatment protocols were rapidly screened in 4-week experiments using small groups of animals to ensure against rigorous testing of futile treatment protocols. The antiepileptogenic effects of brivaracetam treatment initiated 30 minutes, 4 hours, and 8 hours after rostral parasagittal fluid percussion injury (rpFPI) were then compared with vehicle-treated controls in a fully powered blind and randomized 16-week validation. Seizures were evaluated by video-electrocorticography using a 5-electrode epidural montage. Endpoint measures included incidence, frequency, duration, and spread of seizures. Group sizes and recording durations were supported by published power analyses. Three months after treatment ended, rats treated with brivaracetam starting at 4 hours post-FPI (the best-performing protocol) experienced a 38% decrease in overall incidence of seizures, 59% decrease in seizure frequency, 67% decrease in time spent seizing, and a 45% decrease in the proportion of spreading seizures that was independent of duration-based seizure definition. Thus, brivaracetam shows both antiepileptogenic and disease-modifying properties after rpFPI. SIGNIFICANCE STATEMENT: The rpFPI model, which likely incorporates epileptogenic mechanisms operating after human head injury, can be used to efficiently screen investigational treatment protocols and assess antiepileptogenic/disease-modifying effects. Our studies 1) support a role for SV2A in epileptogenesis, 2) suggest that brivaracetam and other drugs targeting SV2A should be considered for human clinical trials of prevention of post-traumatic epilepsy after head injury, and 3) provide data to inform the design of treatment protocols for clinical trials.
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Affiliation(s)
- Clifford L Eastman
- Department of Neurological Surgery, University of Washington, Seattle, Washington (C.L.E., J.S.F., R.D.); and Mid-Atlantic Epilepsy and Sleep Center, Bethesda, Maryland (P.K.)
| | - Jason S Fender
- Department of Neurological Surgery, University of Washington, Seattle, Washington (C.L.E., J.S.F., R.D.); and Mid-Atlantic Epilepsy and Sleep Center, Bethesda, Maryland (P.K.)
| | - Pavel Klein
- Department of Neurological Surgery, University of Washington, Seattle, Washington (C.L.E., J.S.F., R.D.); and Mid-Atlantic Epilepsy and Sleep Center, Bethesda, Maryland (P.K.)
| | - Raimondo D'Ambrosio
- Department of Neurological Surgery, University of Washington, Seattle, Washington (C.L.E., J.S.F., R.D.); and Mid-Atlantic Epilepsy and Sleep Center, Bethesda, Maryland (P.K.)
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Perucca E. The pharmacological treatment of epilepsy: recent advances and future perspectives. ACTA EPILEPTOLOGICA 2021. [DOI: 10.1186/s42494-021-00055-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AbstractThe pharmacological armamentarium against epilepsy has expanded considerably over the last three decades, and currently includes over 30 different antiseizure medications. Despite this large armamentarium, about one third of people with epilepsy fail to achieve sustained seizure freedom with currently available medications. This sobering fact, however, is mitigated by evidence that clinical outcomes for many people with epilepsy have improved over the years. In particular, physicians now have unprecedented opportunities to tailor treatment choices to the characteristics of the individual, in order to maximize efficacy and tolerability. The present article discusses advances in the drug treatment of epilepsy in the last 5 years, focusing in particular on comparative effectiveness trials of second-generation drugs, the introduction of new pharmaceutical formulations for emergency use, and the results achieved with the newest medications. The article also includes a discussion of potential future developments, including those derived from advances in information technology, the development of novel precision treatments, the introduction of disease modifying agents, and the discovery of biomarkers to facilitate conduction of clinical trials as well as routine clinical management.
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Efficacy of Brivaracetam in children with epilepsy. Epilepsy Res 2021; 177:106757. [PMID: 34530305 DOI: 10.1016/j.eplepsyres.2021.106757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 08/21/2021] [Accepted: 09/07/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES To determine the efficacy, tolerance, and safety of BRV in children with epilepsy. METHODS A retrospective study of patients with epilepsy who received treatment with BRV before age 16 years and underwent a minimum follow-up of 3 months. METHOD AND RESULTS Sixty-six patients were included in the study. Patients received BRV at a mean age of 8.8 years (range 1-16 years). The majority (93.4 %) had refractory epilepsy, 27 with epileptic encephalopathy. The median maximum dose used was 4.3 mg/kg/day. In 30.3 % of the cases, seizure frequency was reduced by over 50 %, and 9 % remained seizure-free. Greater efficacy was observed in those patients who received higher doses and when a direct switch from levetiracetam (LEV) to BRV was performed. The ineffectiveness of LEV was not related to a failure to respond to BRV treatment. Side effects were identified in 24.2 % of the cases, the most frequent being irritability and drowsiness. CONCLUSIONS BRV appears to be an effective, safe, and well-tolerated AED in children with refractory epilepsy.
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Lou S, Cui S. Drug treatment of epilepsy: From serendipitous discovery to evolutionary mechanisms. Curr Med Chem 2021; 29:3366-3391. [PMID: 34514980 DOI: 10.2174/0929867328666210910124727] [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: 05/07/2021] [Revised: 07/17/2021] [Accepted: 07/21/2021] [Indexed: 11/22/2022]
Abstract
Epilepsy is a chronic brain disorder caused by abnormal firing of neurons. Up to now, using antiepileptic drugs is the main method of epilepsy treatment. The development of antiepileptic drugs lasted for centuries. In general, most agents entering clinical practice act on the balance mechanisms of brain "excitability-inhibition". More specifically, they target voltage-gated ion channels, GABAergic transmission and glutamatergic transmission. In recent years, some novel drugs representing new mechanisms of action have been discovered. Although there are about 30 available drugs in the market, it is still in urgent need of discovering more effective and safer drugs. The development of new antiepileptic drugs is into a new era: from serendipitous discovery to evolutionary mechanism-based design. This article presents an overview of drug treatment of epilepsy, including a series of traditional and novel drugs.
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Affiliation(s)
- Shengying Lou
- Institute of Drug Discovery and Design, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou. China
| | - Sunliang Cui
- Institute of Drug Discovery and Design, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou. China
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Karaźniewicz-Łada M, Główka AK, Mikulska AA, Główka FK. Pharmacokinetic Drug-Drug Interactions among Antiepileptic Drugs, Including CBD, Drugs Used to Treat COVID-19 and Nutrients. Int J Mol Sci 2021; 22:ijms22179582. [PMID: 34502487 PMCID: PMC8431452 DOI: 10.3390/ijms22179582] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/23/2021] [Accepted: 08/31/2021] [Indexed: 12/22/2022] Open
Abstract
Anti-epileptic drugs (AEDs) are an important group of drugs of several generations, ranging from the oldest phenobarbital (1912) to the most recent cenobamate (2019). Cannabidiol (CBD) is increasingly used to treat epilepsy. The outbreak of the SARS-CoV-2 pandemic in 2019 created new challenges in the effective treatment of epilepsy in COVID-19 patients. The purpose of this review is to present data from the last few years on drug–drug interactions among of AEDs, as well as AEDs with other drugs, nutrients and food. Literature data was collected mainly in PubMed, as well as google base. The most important pharmacokinetic parameters of the chosen 29 AEDs, mechanism of action and clinical application, as well as their biotransformation, are presented. We pay a special attention to the new potential interactions of the applied first-generation AEDs (carbamazepine, oxcarbazepine, phenytoin, phenobarbital and primidone), on decreased concentration of some medications (atazanavir and remdesivir), or their compositions (darunavir/cobicistat and lopinavir/ritonavir) used in the treatment of COVID-19 patients. CBD interactions with AEDs are clearly defined. In addition, nutrients, as well as diet, cause changes in pharmacokinetics of some AEDs. The understanding of the pharmacokinetic interactions of the AEDs seems to be important in effective management of epilepsy.
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Affiliation(s)
- Marta Karaźniewicz-Łada
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, 60-781 Poznań, Poland; (M.K.-Ł.); (A.A.M.)
| | - Anna K. Główka
- Department of Bromatology, Poznan University of Medical Sciences, 60-354 Poznań, Poland;
| | - Aniceta A. Mikulska
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, 60-781 Poznań, Poland; (M.K.-Ł.); (A.A.M.)
| | - Franciszek K. Główka
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, 60-781 Poznań, Poland; (M.K.-Ł.); (A.A.M.)
- Correspondence: ; Tel.: +48-(0)61-854-64-37
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de Jong J, Cutcutache I, Page M, Elmoufti S, Dilley C, Fröhlich H, Armstrong M. Towards realizing the vision of precision medicine: AI based prediction of clinical drug response. Brain 2021; 144:1738-1750. [PMID: 33734308 PMCID: PMC8320273 DOI: 10.1093/brain/awab108] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/05/2021] [Accepted: 02/23/2021] [Indexed: 01/25/2023] Open
Abstract
Accurate and individualized prediction of response to therapies is central to precision medicine. However, because of the generally complex and multifaceted nature of clinical drug response, realizing this vision is highly challenging, requiring integrating different data types from the same individual into one prediction model. We used the anti-epileptic drug brivaracetam as a case study and combine a hybrid data/knowledge-driven feature extraction with machine learning to systematically integrate clinical and genetic data from a clinical discovery dataset (n = 235 patients). We constructed a model that successfully predicts clinical drug response [area under the curve (AUC) = 0.76] and show that even with limited sample size, integrating high-dimensional genetics data with clinical data can inform drug response prediction. After further validation on data collected from an independently conducted clinical study (AUC = 0.75), we extensively explore our model to gain insights into the determinants of drug response, and identify various clinical and genetic characteristics predisposing to poor response. Finally, we assess the potential impact of our model on clinical trial design and demonstrate that, by enriching for probable responders, significant reductions in clinical study sizes may be achieved. To our knowledge, our model represents the first retrospectively validated machine learning model linking drug mechanism of action and the genetic, clinical and demographic background in epilepsy patients to clinical drug response. Hence, it provides a blueprint for how machine learning-based multimodal data integration can act as a driver in achieving the goals of precision medicine in fields such as neurology.
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Affiliation(s)
- Johann de Jong
- Data and Translational Sciences, UCB Biosciences GmbH, 40789 Monheim am Rhein, Germany
| | | | - Matthew Page
- Data and Translational Sciences, UCB Pharma, Slough SL1 3WE, UK
| | - Sami Elmoufti
- Late Development Statistics, UCB Biosciences Inc., Raleigh, NC 27617, USA
| | | | - Holger Fröhlich
- Data and Translational Sciences, UCB Biosciences GmbH, 40789 Monheim am Rhein, Germany
- Fraunhofer Institute for Scientific Computing and Algorithms (SCAI), Business Area Bioinformatics, 53757 Sankt Augustin, Germany
- Bonn-Aachen International Center for IT, University of Bonn, 53115 Bonn, Germany
| | - Martin Armstrong
- Data and Translational Sciences, UCB Pharma, 1420 Braine l’Alleud, Belgium
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Choppari T, Gunnam S, Chennuru LN, Cherla PM, Talluri MVNK. Evaluation of Chiral Liquid Chromatographic Method for Separation and Quantification of Isomers of Brivaracetam. J Chromatogr Sci 2021; 60:250-259. [PMID: 34173643 DOI: 10.1093/chromsci/bmab075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 01/13/2021] [Accepted: 05/29/2021] [Indexed: 11/15/2022]
Abstract
A selective, sensitive and robust chiral analytical method was developed for the quantification of Brivaracetam (BRV) and its three isomers. Systematic chiral chromatographic elution process was executed in different modes on chiral columns of polysaccharide based to attain the finest condition. The analytical method was developed by utilizing immobilized polysaccharide chiral column (CHIRALPAK IG-U) with reversed phase under isocratic condition containing acetonitrile and 10 mM ammonium bicarbonate in the proportion of 40:60 (v/v). The mobile phase flow rate and column temperature were monitored at 0.3 mLmin-1 and 25°C with a resolution of more than 2.0. The eluted components from the column were processed at 212 nm UV detection. The limit of detection and limit of quantification values of BRV, 2R, 4S-Isomer, 2R, 4R-Isomer and 2S, 4S-Isomers were found to be 0.0066/0.02, 0.0035/0.0107, 0.0036/0.0109 and 0.005/0.0152 µgml-1 respectively. Precision, linearity, accuracy and robustness were conducted according to ICH guidelines and the findings were within the acceptable limits. The proposed analytical method was found to be precise, accurate and specific for the quantification of enantiomer and its diastereomers for drug product and drug substance of BRV.
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Affiliation(s)
- Thirupathi Choppari
- Analytical & Separation Services, Daicel Chiral Technologies (India) Pvt Ltd, Survey No. 542/2, IKP Knowledge Park, Turkapally, Shamirpet Mandal, Medchal-Malkajgiri District, Hyderabad-500101, Telangana, India
| | - Srinivasu Gunnam
- Analytical & Separation Services, Daicel Chiral Technologies (India) Pvt Ltd, Survey No. 542/2, IKP Knowledge Park, Turkapally, Shamirpet Mandal, Medchal-Malkajgiri District, Hyderabad-500101, Telangana, India
| | - Lakshmi Narayana Chennuru
- Analytical & Separation Services, Daicel Chiral Technologies (India) Pvt Ltd, Survey No. 542/2, IKP Knowledge Park, Turkapally, Shamirpet Mandal, Medchal-Malkajgiri District, Hyderabad-500101, Telangana, India
| | - Parameswara Murthy Cherla
- Department of Chemistry, University college of science, Osmania University campus, Hyderabad-500007, Telangana, India
| | - M V N Kumar Talluri
- Analytical & Separation Services, Daicel Chiral Technologies (India) Pvt Ltd, Survey No. 542/2, IKP Knowledge Park, Turkapally, Shamirpet Mandal, Medchal-Malkajgiri District, Hyderabad-500101, Telangana, India
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Rogalewski A, Zuhorn F, Wilkens L, Krüger M, Klingebiel R, Schäbitz WR. Severe drug-induced liver injury caused by levetiracetam - A case report and review of the literature. Epilepsy Behav Rep 2021; 16:100464. [PMID: 34235418 PMCID: PMC8246146 DOI: 10.1016/j.ebr.2021.100464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 12/24/2022] Open
Abstract
Levetiracetam (LEV) is a broad-spectrum, second-generation anti-seizure medication, which has quickly become one of the most commonly prescribed drugs for people with epielpsy due to its good tolerability, rapid up-dosing capability, with both parenteral and enteral routes of administration. Considering the frequent prescriptions and predominant excretion by the kidney with minimal hepatic metabolism, severe liver injury is very rarely a complication associated with LEV. An analysis of this reported case and further published cases was performed with respect to indication, relevant previous liver diseases, concomitant medication, and both the dosage as well as the duration of LEV when drug-induced liver injury (DILI) was noted. DILI occurs after a few days to a maximum of five months after initiation of therapy with LEV and, in the worst case, may require liver transplantation or result in death. Monitoring of serum transaminase values may be helpful. Discontinuing LEV is the first therapeutic measure. In addition, immunosuppression with cortisone can be considered for serious cases.
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Affiliation(s)
- Andreas Rogalewski
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL of the University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Frédéric Zuhorn
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL of the University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
| | | | - Martin Krüger
- Department of Internal Medicine and Gastroenterology, University Hospital OWL of the University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Randolf Klingebiel
- Department of Neuroradiology, Evangelisches Klinikum Bethel, University Hospital OWL of the University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Wolf-Rüdiger Schäbitz
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL of the University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
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Fenfluramine in the successful treatment of super-refractory status epilepticus in a patient with Dravet syndrome. Epilepsy Behav Rep 2021; 16:100461. [PMID: 34179745 PMCID: PMC8214086 DOI: 10.1016/j.ebr.2021.100461] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/19/2021] [Accepted: 05/08/2021] [Indexed: 11/25/2022] Open
Abstract
Dravet syndrome (DS) patient in super-refractory status epilepticus (SRSE) for 5 weeks. Add-on fenfluramine (FFA) successfully treated SRSE in DS. Most effective dose of FFA was 0.7 mg/kg/day. Long-term FFA provided >90% reduction in seizures and prevented status epilepticus. FFA maintenance also resulted in improvement of neurocognitive function.
A 20-year-old woman with Dravet syndrome and multiple prior episodes of status epilepticus presented to our hospital in November 2018 in super-refractory status epilepticus. After 5 weeks of unsuccessful continuous treatment with anesthetics, including pentobarbital and ketamine, we sought and were granted an emergency approval by the United States Food and Drug Administration to administer fenfluramine, an investigational new drug, to this patient. One week of treatment with fenfluramine at 0.4 mg/kg/day was ineffective. The dose of fenfluramine was titrated to 0.7 mg/kg/day, and after 1 week, electrographic seizures ceased. One week later, the patient was seizure-free and off all anesthetic agents. Add-on treatment with fenfluramine was continued with no further episodes of status epilepticus and >90% reduction in tonic-clonic seizures. This case report illustrates the potential for fenfluramine to prevent reoccurrence of status epilepticus and to manage super-refractory status epilepticus in patients with Dravet syndrome.
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Tulli E, Di Cara G, Iapadre G, Striano P, Verrotti A. An update on brivaracetam for the treatment of pediatric partial epilepsy. Expert Opin Pharmacother 2021; 22:1387-1395. [PMID: 33896317 DOI: 10.1080/14656566.2021.1921151] [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] [Indexed: 10/21/2022]
Abstract
Introduction: Brivaracetam (BRV) is an antiseizure medication (ASM), which has been approved as an adjunctive treatment in adults and pediatric patients aged four years and older with focal onset seizures. It is a second-generation levetiracetam (LEV) derivative, sharing the same mechanism of action, binding synaptic vesicles 2A (SV2A). BRV shows higher binding affinity and selectivity and higher brain permeability than LEV.Areas covered: This article reviews randomized controlled trials, retrospective and prospective studies published up to December 2020, searched in electronic databases MEDLINE, EMBASE and the Clinical Trial Database and provide an overview of efficacy, safety and tolerability of BRV in pediatric patients with partial epilepsy. Furthermore, the authors provide their expert opinion on the drug and give their future perspectives.Expert opinion: The analysis of the literature data has demonstrated the safety and efficacy of BRV in pediatric patients, with more evidence in children aged 4 to 16 years with an onset of focal seizures. However, a positive response was also achieved in patients affected by some encephalopathic epilepsies. Comparative efficacy studies between BRV and other ASMs, in addition to well-designed RCTs that include larger pediatric populations are needed to better define the role and potentiality of this ASM.
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Affiliation(s)
- Eleonora Tulli
- Department of Pediatrics, University of Perugia, Perugia, Italy
| | | | - Giulia Iapadre
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscolar Diseases Unit, IRRCS Istituto Giannina Gaslini, Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
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Neurocognitive Effects of Antiseizure Medications in Children and Adolescents with Epilepsy. Paediatr Drugs 2021; 23:253-286. [PMID: 33956338 DOI: 10.1007/s40272-021-00448-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/08/2022]
Abstract
Impairments in cognition are common in epilepsy and may be caused or exacerbated by antiseizure medications (ASMs). Positive effects on cognition may also be seen with some ASMs. Cognitive outcomes are of particular concern in children who may be at an increased risk of cognitive adverse effects of treatment. A comprehensive literature search was conducted in PubMed in order to evaluate the evidence for cognitive changes associated with treatment with ASMs in paediatric epilepsy patients. The ASMs considered were those in the current edition of the British National Formulary (BNF). For most ASMs, remarkably few studies providing robust data on cognitive effects in paediatric patients were identified. The available evidence suggests cognitive impairments may be associated with treatment with phenobarbital. Topiramate and phenytoin are also associated with negative effects on cognition, in particular word-finding difficulties and other language deficits with topiramate, but there are few data available specifically on children. Lamotrigine, levetiracetam and fenfluramine are associated with improvements in some cognitive domains, although it is unclear whether these effects are directly attributable to the medications or are a result of improvements in seizures. Neutral effects on cognition (no substantial evidence of worsening) were suggested for carbamazepine, everolimus, lacosamide, oxcarbazepine, perampanel and valproate. There is limited data for cannabidiol, clobazam, eslicarbazepine acetate, ethosuximide, rufinamide, vigabatrin and zonisamide, although the available evidence suggests these drugs are not associated with severe cognitive impairment. There was too little information to reach conclusions about the effects of brivaracetam, felbamate, gabapentin, pregabalin, retigabine, stiripentol or tiagabine.
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Jędrzejczak J, Majkowska-Zwolińska B, Chudzicka-Bator A, Żerda I, Władysiuk M, Godman B. Economic and social cost of epilepsy in Poland: 5-year analysis. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:485-497. [PMID: 33582892 DOI: 10.1007/s10198-021-01269-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 01/16/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Epilepsy affects nearly 50 million people around the world. As a common and chronic disease generates a high cost burden for healthcare system and patients. AIM We aimed to determine the most current direct and indirect costs of epilepsy in Poland from the social perspective for the years 2014-2018, to analyze the changes of expenditures over time, indicate trends and to determine key cost-drivers. MATERIAL AND METHODS Direct and indirect costs using a top-down approach were estimated based on the public institutions' data for the ICD-10 codes G40 and G41. Direct costs included pharmacotherapy, hospitalizations, outpatient specialist care and rehabilitation. A human capital approach was used to estimate loss of productivity due to sick leaves and long-term inability to work. RESULTS Annual total direct and indirect costs related to epilepsy accounted for EUR 410 million in 2014 and decreased in subsequent years to EUR 361 million in 2018. The indirect costs were dominant (76-83% of total costs) and in the majority related to the long-term absenteeism (87-92% of total indirect costs). In 2014-2018, patients with epilepsy generated EUR 341 million to EUR 282 million of indirect costs. Annual direct costs for patients with epilepsy were EUR 69 million in 2014 and increased to EUR 80 million in 2018. The biggest expenses were the costs of drugs (> 50%) and hospitalizations (~ 40%). CONCLUSIONS Epilepsy is an expensive disorder in terms of consumption of resources and social costs. Decision-makers should take it under special consideration.
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Affiliation(s)
- Joanna Jędrzejczak
- Department of Neurology and Epileptology, Centre of Postgraduate Medical Education, Warsaw, Poland
- Epilepsy Diagnostic and Therapeutic Centre of Epilepsy Foundation of Epileptology, Warsaw, Poland
| | - Beata Majkowska-Zwolińska
- Epilepsy Diagnostic and Therapeutic Centre of Epilepsy Foundation of Epileptology, Warsaw, Poland
- Łazarski University, Warsaw, Poland
| | | | - Iwona Żerda
- HTA Consulting sp. z o.o. sp. k, Krakow, Poland
| | | | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, G4 ORE, UK
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden
- Health Economics Centre, Liverpool University Management School, Chatham Street, Liverpool, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Hung TY, Wu SN, Huang CW. The Integrated Effects of Brivaracetam, a Selective Analog of Levetiracetam, on Ionic Currents and Neuronal Excitability. Biomedicines 2021; 9:biomedicines9040369. [PMID: 33916190 PMCID: PMC8067033 DOI: 10.3390/biomedicines9040369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/17/2021] [Accepted: 03/26/2021] [Indexed: 12/22/2022] Open
Abstract
Brivaracetam (BRV) is recognized as a novel third-generation antiepileptic drug approved for the treatment of epilepsy. Emerging evidence has demonstrated that it has potentially better efficacy and tolerability than its analog, Levetiracetam (LEV). This, however, cannot be explained by their common synaptic vesicle-binding mechanism. Whether BRV can affect different ionic currents and concert these effects to alter neuronal excitability remains unclear. With the aid of patch clamp technology, we found that BRV concentration dependently inhibited the depolarization-induced M-type K+ current (IK(M)), decreased the delayed-rectifier K+ current (IK(DR)), and decreased the hyperpolarization-activated cation current in GH3 neurons. However, it had a concentration-dependent inhibition on voltage-gated Na+ current (INa). Under an inside-out patch configuration, a bath application of BRV increased the open probability of large-conductance Ca2+-activated K+ channels. Furthermore, in mHippoE-14 hippocampal neurons, the whole-cell INa was effectively depressed by BRV. In simulated modeling of hippocampal neurons, BRV was observed to reduce the firing of the action potentials (APs) concurrently with decreases in the AP amplitude. In animal models, BRV ameliorated acute seizures in both OD-1 and lithium-pilocarpine epilepsy models. However, LEV had effects in the latter only. Collectively, our study demonstrated BRV’s multiple ionic mechanism in electrically excitable cells and a potential concerted effect on neuronal excitability and hyperexcitability disorders.
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Affiliation(s)
- Te-Yu Hung
- Department of Pediatrics, Chi-Mei Medical Center, Tainan 71004, Taiwan;
| | - Sheng-Nan Wu
- Department of Physiology, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
- Correspondence: (S.-N.W.); (C.-W.H.)
| | - Chin-Wei Huang
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
- Correspondence: (S.-N.W.); (C.-W.H.)
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Steinhoff BJ. Cenobamate tablets as a treatment for focal-onset seizures in adults. Expert Rev Clin Pharmacol 2021; 14:161-172. [PMID: 33470139 DOI: 10.1080/17512433.2021.1879637] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Despite the introduction of numerous new antiseizure medications (ASMs) still about one-third of epilepsies remain drug-resistant. Therefore, new compounds with advanced efficacy are urgently needed. Cenobamate (CNB) is a new ASM that has been recently introduced in the United States for the treatment of adults with focal-onset seizures. The approval in Europe is under way.Areas covered: This review covers the pharmacological profile of CNB, the proof-of-concept trial, the two double-blind, placebo-controlled phase 2 trials investigating adjunct CNB in adults with focal-onset seizures, one open-label safety trial, and a variety of published abstract material that provided additional post hoc data.Expert opinion: In two placebo-controlled randomized multicenter phase 2 trials adjunct CNB showed unusually high efficacy with rates of seizure-free people with epilepsy (PWE) partially beyond 20%. However, during the clinical program cases of drug-related reactions with eosinophilia and systemic symptoms (DRESS syndrome) occurred. Therefore, an open-label safety study was performed in more than 1300 PWE with particularly slower titration schedules which did not add more cases with similar reactions. Taking into consideration the promising efficacy and the safety experience from the open-label trial, CNB applied according to the meanwhile recommended titration strategy, might offer a new prospect.
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Affiliation(s)
- Bernhard J Steinhoff
- Kork Epilepsy Center, Kehl-Kork, Germany.,Department of Neurology, Albert-Ludwigs University of Freiburg, Freiburg, Germany
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Bortolami M, Rocco D, Messore A, Di Santo R, Costi R, Madia VN, Scipione L, Pandolfi F. Acetylcholinesterase inhibitors for the treatment of Alzheimer's disease - a patent review (2016-present). Expert Opin Ther Pat 2021; 31:399-420. [PMID: 33428491 DOI: 10.1080/13543776.2021.1874344] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction - AD, the most common form of dementia, has a multifactorial etiology, and the current therapy (AChEIs and memantine) is unable to interrupt its progress and fatal outcome. This is reflected in the research programs that are oriented toward the development of new therapeutics able to operate on multiple targets involved in the disease progression.Areas covered - The patents from 2016 to present regarding the use of AChEIs in AD, concerns the development of new AChEIs, multitarget or multifunctional ligands, or the associations of currently used AChEIs with other compounds acting on different targets involved in the AD.Expert opinion - The development of new multitarget AChEIs promises to identify compounds with great therapeutic potential but requires more time and effort in order to obtain drugs with the optimal pharmacodynamic profile. Otherwise, the research on new combinations of existing drugs, with known pharmacodynamic and ADME profile, could shorten the time and reduce the costs to develop a new therapeutic treatment for AD. From the analyzed data, it seems more likely that a response to the urgent need to develop effective treatments for AD therapy could come more quickly from studies on drug combinations than from the development of new AChEIs.
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Affiliation(s)
- Martina Bortolami
- Department of Scienze Di Base E Applicate per l'Ingegneria, Sapienza University of Rome, Rome, Italy
| | - Daniele Rocco
- Department of Scienze Di Base E Applicate per l'Ingegneria, Sapienza University of Rome, Rome, Italy
| | - Antonella Messore
- Department of Chimica E Tecnologia Del Farmaco, Dipartimento Di Eccellenza 2018-2022, Istituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University of Rome, Rome, Italy
| | - Roberto Di Santo
- Department of Chimica E Tecnologia Del Farmaco, Dipartimento Di Eccellenza 2018-2022, Istituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University of Rome, Rome, Italy
| | - Roberta Costi
- Department of Chimica E Tecnologia Del Farmaco, Dipartimento Di Eccellenza 2018-2022, Istituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University of Rome, Rome, Italy
| | - Valentina Noemi Madia
- Department of Chimica E Tecnologia Del Farmaco, Dipartimento Di Eccellenza 2018-2022, Istituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University of Rome, Rome, Italy
| | - Luigi Scipione
- Department of Chimica E Tecnologia Del Farmaco, Dipartimento Di Eccellenza 2018-2022, Istituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University of Rome, Rome, Italy
| | - Fabiana Pandolfi
- Department of Scienze Di Base E Applicate per l'Ingegneria, Sapienza University of Rome, Rome, Italy
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Sime FB, Roberts JA, Jeffree RL, Pandey S, Adiraju S, Livermore A, Butler J, Parker SL, Wallis SC, Lipman J, Cotta MO. Population Pharmacokinetics of Levetiracetam in Patients with Traumatic Brain Injury and Subarachnoid Hemorrhage Exhibiting Augmented Renal Clearance. Clin Pharmacokinet 2021; 60:655-664. [PMID: 33428169 DOI: 10.1007/s40262-020-00979-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Patients with severe trauma exhibit augmented renal clearance, which can alter the dosing requirement of renally eliminated drugs. This study aimed to develop a population pharmacokinetic model for levetiracetam in patients with severe traumatic brain injury and aneurysmal subarachnoid hemorrhage, and use it to describe optimal dosing regimens. METHODS This was a prospective open-label observational study. Critically ill adult patients with severe traumatic brain injury or aneurysmal subarachnoid hemorrhage without renal dysfunction and receiving levetiracetam were eligible. Serial levetiracetam plasma concentrations were analyzed to develop a population pharmacokinetic model and perform dosing simulations. RESULTS A two-compartment model best described the concentration-time data from 30 patients. The mean ± standard deviation parameter estimates were bioavailability (F) of 0.8 ± 0.2, absorption rate constant of 2.4 ± 2 h-1, clearance 2.5 ± 1.1 L/h, central volume of distribution 8.9 ± 3.0 L/h, and transfer rate constraints of 1.8 ± 1.1 h-1 from central to peripheral compartments and 0.7 ± 0.3 h-1 from peripheral to central compartments. For the simulated intermittent dosing regimens, on average, the median trough concentration reduced by 50% for every 40-mL/min/1.73 m2 increase in urinary creatinine clearance. Simulated doses of at least 6 g/day were required for some levels of augmented renal clearance. CONCLUSIONS Patients with severe traumatic brain injury and aneurysmal subarachnoid hemorrhage with augmented renal clearance are at risk of not achieving target levetiracetam plasma concentrations. We suggest dose titration guided by measured creatinine clearance, and/or, therapeutic drug monitoring if available, to minimize the risk of seizures.
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Affiliation(s)
- Fekade Bruck Sime
- University of Queensland Centre for Clinical Research, The University of Queensland, Building 71/918, Royal Brisbane & Women's Hospital Campus, Herston, QLD, 4029, Australia. .,Centre for Translational Anti-Infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia.
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research, The University of Queensland, Building 71/918, Royal Brisbane & Women's Hospital Campus, Herston, QLD, 4029, Australia.,Centre for Translational Anti-Infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia.,Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Department of Intensive Care, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Division of Anesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Rosalind L Jeffree
- Kenneth G. Jamieson Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Saurabh Pandey
- University of Queensland Centre for Clinical Research, The University of Queensland, Building 71/918, Royal Brisbane & Women's Hospital Campus, Herston, QLD, 4029, Australia
| | - Santosh Adiraju
- University of Queensland Centre for Clinical Research, The University of Queensland, Building 71/918, Royal Brisbane & Women's Hospital Campus, Herston, QLD, 4029, Australia
| | - Amelia Livermore
- Department of Intensive Care, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Jenie Butler
- Department of Intensive Care, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Suzanne L Parker
- University of Queensland Centre for Clinical Research, The University of Queensland, Building 71/918, Royal Brisbane & Women's Hospital Campus, Herston, QLD, 4029, Australia
| | - Steven C Wallis
- University of Queensland Centre for Clinical Research, The University of Queensland, Building 71/918, Royal Brisbane & Women's Hospital Campus, Herston, QLD, 4029, Australia
| | - Jeffrey Lipman
- University of Queensland Centre for Clinical Research, The University of Queensland, Building 71/918, Royal Brisbane & Women's Hospital Campus, Herston, QLD, 4029, Australia.,Department of Intensive Care, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Division of Anesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Menino Osbert Cotta
- University of Queensland Centre for Clinical Research, The University of Queensland, Building 71/918, Royal Brisbane & Women's Hospital Campus, Herston, QLD, 4029, Australia. .,Centre for Translational Anti-Infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia.
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Panda PK, Saini K, Sharawat IK. Intravenous brivaracetam and lorazepam for acute seizure control: Are they equally effective? Epilepsy Behav 2020; 113:107481. [PMID: 33004278 DOI: 10.1016/j.yebeh.2020.107481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/06/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Kanwar Saini
- All India Institute of Medical Sciences, Pediatrics, Rishikesh, India
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Lamouret V, Kurth C, Intravooth T, Steinhoff BJ. Is the anticonvulsant activity of levetiracetam dose-dependent? Seizure 2020; 83:197-202. [PMID: 33197757 DOI: 10.1016/j.seizure.2020.10.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/22/2020] [Accepted: 10/24/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Although levetiracetam (LEV) is globally established as a leading antiseizure medication (ASM) it is still a controversial matter whether dose increases correspond with an increased efficacy if LEV in the recommended dose range did not show satisfying efficacy. In our clinical perception we questioned the value of dose increases in such non-responders. METHODS In this retrospective monocenter study we analyzed the data of adult people with epilepsies (PWE) with focal-onset seizures who had been treated at the department of adults of the Kork Epilepsy Center between 2009 and 2019, who had been on a stable daily LEV dose and in whom LEV was further increased due to further seizures in spite of baseline LEV in a recommended daily dose range. For reasons of data homogeneity, we included only PWE with at least two definite seizures during the hospital stay under the baseline LEV dose who were treated and observed as in-patients after the increase of LEV for a period at least three-fold longer than the baseline interval before. Additional data acquisition comprised clinical data including adverse events, serum concentrations of LEV and other ASMs, and additional laboratory findings. The primary outcome variable was the change of seizure frequency prior to and after the increase of LEV. RESULTS Out of 518 PWE who had been on LEV during their hospital stay, a total of 61 PWE fulfilled the inclusion criteria. After a gradual dose increment, 91,8 % of PWE showed a reduced seizure frequency, 73,8 % had a reduction of seizures of 50 % or more, and 21,3 % were seizure-free during the observation period. A significant seizure reduction could be shown with a seizure count of 2,5/week prior to the increment and 0,7/week after dose increment (p < 0,00001). Seven PWE reported minor adverse events and ten PWE showed slight laboratory changes (within normal levels). CONCLUSION Contrary to our long-term clinical impression, LEV dose increments were reasonable and improved the seizure situation in PWE, usually without additional safety hazards.
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Affiliation(s)
- Valerija Lamouret
- Kork Epilepsy Center, Kehl-Kork, Germany; Department of Pediatrics, St-Elisabethen-Krankenhaus, Lörrach, Germany
| | | | | | - Bernhard J Steinhoff
- Kork Epilepsy Center, Kehl-Kork, Germany; University Hospital of Neurology, Freiburg, Germany.
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Sommerfeld-Klatta K, Zielińska-Psuja B, Karaźniewcz-Łada M, Główka FK. New Methods Used in Pharmacokinetics and Therapeutic Monitoring of the First and Newer Generations of Antiepileptic Drugs (AEDs). Molecules 2020; 25:E5083. [PMID: 33147810 PMCID: PMC7663638 DOI: 10.3390/molecules25215083] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/23/2020] [Accepted: 10/28/2020] [Indexed: 12/30/2022] Open
Abstract
The review presents data from the last few years on bioanalytical methods used in therapeutic drug monitoring (TDM) of the 1st-3rd generation and the newest antiepileptic drug (AEDs) cenobamate in patients with various forms of seizures. Chemical classification, structure, mechanism of action, pharmacokinetic data and therapeutic ranges for total and free fractions and interactions were collected. The primary data on bioanalytical methods for AEDs determination included biological matrices, sample preparation, dried blood spot (DBS) analysis, column resolution, detection method, validation parameters, and clinical utility. In conclusion, the most frequently described method used in AED analysis is the LC-based technique (HPLC, UHPLC, USLC) combined with highly sensitive mass detection or fluorescence detection. However, less sensitive UV is also used. Capillary electrophoresis and gas chromatography have been rarely applied. Besides the precipitation of proteins or LLE, an automatic SPE is often a sample preparation method. Derivatization was also indicated to improve sensitivity and automate the analysis. The usefulness of the methods for TDM was also highlighted.
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Affiliation(s)
- Karina Sommerfeld-Klatta
- Department of Toxicology, Poznan University of Medical Sciences, 60-631 Poznań, Poland; (K.S.-K.); (B.Z.-P.)
| | - Barbara Zielińska-Psuja
- Department of Toxicology, Poznan University of Medical Sciences, 60-631 Poznań, Poland; (K.S.-K.); (B.Z.-P.)
| | - Marta Karaźniewcz-Łada
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, 60-781 Poznań, Poland;
| | - Franciszek K. Główka
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, 60-781 Poznań, Poland;
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Abstract
PURPOSE OF REVIEW Depression and anxiety substantially contribute to interictal disability in patients with epilepsy (PWE). This review summarizes current studies that shed light on mechanisms of comorbidity. RECENT FINDINGS Mounting epidemiological data implicate shared risk factors for anxiety/depression and seizure propensity, but these remain largely elusive and probably vary by epilepsy type. Within PWE, these symptoms appear to be associated with unique genetic, neuropathological, and connectivity profiles. Temporal lobe epilepsy has received enormous emphasis particularly in preclinical studies of comorbidity, where candidate neurobiological mechanisms underlying bidirectionality have been tested without psychopharmacological confounds. Depression and anxiety in epilepsy reflect dysfunction within broadly distributed limbic networks that may be the cause or consequence of epileptogenesis. In refractory epilepsy, seizures and/or certain anticonvulsants may distort central emotional homeostatic mechanisms that perpetually raise seizure risk. Developing future safe and effective combined anticonvulsant-antidepressant treatments will require a detailed understanding of anatomical and molecular nodes that pleiotropically enhance seizure risk and negatively alter emotionality.
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Affiliation(s)
- Vaishnav Krishnan
- Departments of Neurology, Neuroscience and Psychiatry & Behavioral Sciences, Baylor Comprehensive Epilepsy Center, Baylor College of Medicine, One Baylor Plaza St., MS: NB302, Houston, TX, 77030, USA.
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Adewusi J, Burness C, Ellawela S, Emsley H, Hughes R, Lawthom C, Maguire M, McLean B, Mohanraj R, Oto M, Singhal S, Reuber M. Brivaracetam efficacy and tolerability in clinical practice: A UK-based retrospective multicenter service evaluation. Epilepsy Behav 2020; 106:106967. [PMID: 32179501 DOI: 10.1016/j.yebeh.2020.106967] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/14/2020] [Accepted: 02/01/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE This multicenter service evaluation explores the efficacy and tolerability of brivaracetam (BRV) in an unselected, consecutive population in 'real-life' clinical settings. METHOD We retrospectively collected data from patient records at 11 UK hospitals and epilepsy centers. Consecutive patients prescribed BRV with at least 3 months of follow-up (FU) were included. Apart from reporting effectiveness and tolerability of BRV across the whole cohort, we compared treatment outcomes depending on previous levetiracetam use (LEV+ versus LEV-), comorbid learning disability (LD+ versus LD-), and epilepsy syndrome (focal versus generalized epilepsy). RESULTS Two hundred and ninety patients (46% male, median age: 38 years, range: 15 to 77) with ≥3 months of FU were included. The median duration of BRV exposure was 12 months (range: 1 day to 72 months). Overall BRV retention was 71.1%. While 56.1% of patients improved in terms of seizure frequency category (daily, weekly, monthly, yearly seizures), 23.1% did not improve on this measure and 20.8% deteriorated. In terms of seizure frequency, 21% of patients experienced a ≥50% reduction, with 7.0% of all patients becoming seizure-free. Treatment-emergent adverse events (AEs) were reported by 107 (36.9%) patients, but there were no serious AEs. The commonest AEs were sedation/fatigue (18.3%), mood changes (9.0%), and irritability/aggression (4.8%). There were no significant differences in drug retention, seizure frequency outcomes, or AEs between the LEV+ and LEV- subgroups, or between patients with generalized or focal epilepsies. Although 15.5% of patients in the LD+ group achieved a ≥50% reduction, this rate was lower than in the LD- group. CONCLUSIONS This 'real-life' evaluation suggests that reductions in seizure frequency can be achieved with BRV in patients with highly refractory epilepsy. Brivaracetam may be a useful treatment option in patients who have previously failed to respond to or tolerate LEV, those with LD, or (off-label) those with generalized epilepsies.
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Affiliation(s)
- J Adewusi
- Academic Neurology Unit, University of Sheffield, UK.
| | - C Burness
- The Walton Centre, NHS Foundation Trust, Liverpool, UK.
| | - S Ellawela
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
| | - H Emsley
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.
| | - R Hughes
- Manchester University NHS Foundation Trust, UK.
| | | | - M Maguire
- Leeds Teaching Hospitals NHS Foundation Trust, Leeds, UK.
| | - B McLean
- Royal Cornwall Hospital NHS Trust, Truro, UK.
| | - R Mohanraj
- Salford Royal NHS Foundation Trust, Manchester, UK.
| | - M Oto
- William Quarriers Epilepsy Centre, Glasgow, UK
| | - S Singhal
- Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - M Reuber
- Academic Neurology Unit, University of Sheffield, UK.
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Steinhoff BJ, Bacher M, Blickhan M, Bernedo V, Dietmann D, Intravooth T, Kornmeier R, Kurth C, Mahn P, Schneider M, Stockinger J, Staack AM. Is brivaracetam-induced elevation of carbamazepine-epoxide levels common and clinically relevant? — A case series. Epilepsy Res 2020; 159:106236. [DOI: 10.1016/j.eplepsyres.2019.106236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/13/2019] [Accepted: 11/03/2019] [Indexed: 12/25/2022]
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