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Santamarina E, Bertol V, Garayoa V, García-Gomara MJ, Garamendi-Ruiz I, Giner P, Aranzábal I, Piera A, Arcos C, Esteve P, Marinas A, García-Escrivá A, Viloria-Alebesque A, Loro FA, de Tienda AP, Olivan JA, Bonet M, Dávila-González P, Sivera R, Molins A, Sansa G, Roche JC, Martínez AB, Monteagudo S, Casadevall T. Efficacy and tolerability of perampanel as a first add-on therapy with different anti-seizure drugs. Seizure 2020; 83:48-56. [PMID: 33096456 DOI: 10.1016/j.seizure.2020.09.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To investigate the efficacy and tolerability of perampanel (PER) when administered as a first add-on therapy to patients with focal epilepsy or idiopathic generalized epilepsy (IGE) taking one other antiseizure drug (ASD). METHODS This multicentre, retrospective, one-year observational study collected data from patients (≥12 years) who initiated treatment with PER as first add-on therapy. Patients had to be experiencing inadequate seizure control on ASD monotherapy and tried ≤3 ASD monotherapies before initiating PER. Multivariate logistic regression analyses were performed, adjusted for the number and type of previous seizures, duration and aetiology of epilepsy. RESULTS Of the 149 patients included in the study (mean age 41 years; 54.4 % male), 118 (79.2 %) were still receiving PER as first add-on treatment after 12 months. Mean PER dose was 6.2 mg/day. At 12 months, 45.6 % were seizure-free and 84.6 % responders. A significant difference in seizure freedom rate was found between patients with IGE and patients with focal epilepsy, but not in responders. Reduced seizure control was observed when PER was administered with strong enzyme-inducing ASDs; conversely, increased seizure control was seen when the same dose of PER was combined with enzyme-inhibiting ASDs. The most frequent adverse events were dizziness (15.4 %), irritability (14.1 %) and drowsiness (14.1 %); no differences in tolerance were observed among different combinations. CONCLUSION PER demonstrated a good efficacy and safety profile when used as a first add-on therapy in patients who did not respond to monotherapy. PER dose adjustments may optimize seizure control when combined with strong enzyme-inducing or enzyme-inhibiting ASDs.
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Affiliation(s)
| | | | | | | | | | - Pau Giner
- Hospital Universitario Doctor Peset, Valencia, Spain
| | | | - Anna Piera
- Hospital Clínico Universitario, Valencia, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - Albert Molins
- Hospital Universitario Doctor Josep Trueta, Girona, Spain
| | - Gemma Sansa
- Corporació Sanitària Parc Taulí, Sabadell, Spain
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Rohracher A, Kalss G, Leitinger M, Granbichler C, Deak I, Dobesberger J, Kuchukhidze G, Thomschewski A, Höfler J, Trinka E. Two-year real-world experience with perampanel in patients with refractory focal epilepsy: Austrian data. Ther Adv Neurol Disord 2016; 9:445-453. [PMID: 27800020 DOI: 10.1177/1756285616661115] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The aim of this study was to analyse registry data of seizure outcome and adverse events (AEs) for perampanel as add-on therapy in patients with focal epilepsy since its approval in 2012 for adjunctive treatment of focal epilepsy in patients ⩾12 years. METHOD A retrospective 2-year chart review of all patients receiving perampanel was carried out. RESULTS A total of 122 patients received perampanel [median treatment length: 20.1 (range: 3.4-26.8) months]; 71 (58%) remained on treatment at last follow up. Overall, 33 patients (27%) were seizure-free for ⩾3 months at last follow up; of these, eight were seizure free for ⩾3 times the longest interictal interval before perampanel therapy; 18 (15%) had reduced seizure frequency ⩾50%. A total of 58 (47%) had an AE and 34 (28%) withdrew from treatment because of AEs. AEs included dizziness (33%), fatigue (12%), psychiatric symptoms (8%), cognitive deficits (7%), speech problems (5%), nausea (4%) and gait problems (4%). AEs subsided in 17/18 patients (94%) following a 2 mg dose reduction. A total of 43 (35%) took a concomitant enzyme inducer. Patients not taking enzyme inducers were more likely to be seizure free (p = 0.002); there were no other between-group differences. CONCLUSIONS Perampanel was well tolerated and improved seizure control in 42% of patients (50- 100% reduction), with higher rates in those not receiving a concomitant enzyme inducer. AEs, particularly dizziness, were common but often disappeared with a slight dose reduction. The results are consistent with those from randomized controlled trials.
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Affiliation(s)
- Alexandra Rohracher
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Ignaz-Harrer-Straße 79, A-5020 Salzburg, Austria
| | - Gudrun Kalss
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Markus Leitinger
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Claudia Granbichler
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Ildiko Deak
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Judith Dobesberger
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Aljoscha Thomschewski
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Julia Höfler
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Klinik of the Paracelsus Medical University Salzburg, Salzburg, Austria
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10
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Rosenfeld W, Conry J, Lagae L, Rozentals G, Yang H, Fain R, Williams B, Kumar D, Zhu J, Laurenza A. Efficacy and safety of perampanel in adolescent patients with drug-resistant partial seizures in three double-blind, placebo-controlled, phase III randomized clinical studies and a combined extension study. Eur J Paediatr Neurol 2015; 19:435-45. [PMID: 25823975 DOI: 10.1016/j.ejpn.2015.02.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 02/18/2015] [Accepted: 02/21/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Assess perampanel's efficacy and safety as adjunctive therapy in adolescents (ages 12-17) with drug-resistant partial seizures. METHODS Adolescent patients enrolled in multinational, double-blind, placebo-controlled, phase III core studies (studies 304, 305, or 306) completed 19-week, double-blind phase (6-week titration/13-week maintenance) with once-daily perampanel or placebo. Upon completion, patients were eligible for the extension (study 307), beginning with 16-week, blinded conversion, during which placebo patients switched to perampanel. Patients then entered the open-label treatment. RESULTS Of 1480 patients from the core studies, 143 were adolescents. Pooled adolescent data from these core studies demonstrated median percent decreases in seizure frequency for perampanel 8 mg (34.8%) and 12 mg (35.6%) were approximately twice that of placebo (18.0%). Responder rates increased with perampanel 8 mg (40.9%) and 12 mg (45.0%) versus placebo (22.2%). Adolescents receiving concomitant enzyme-inducing antiepileptic drugs (AEDs) had smaller reductions in seizure frequency (8 mg:31.6%; 12 mg:26.8%) than those taking non-inducing AEDs (8 mg:54.6%; 12 mg:52.7%). Relative to pre-perampanel baseline, seizure frequency and responder rates during the extension (Weeks 1-52) improved with perampanel. Most commonly reported adverse events in adolescents during the core studies were dizziness (20.4%), somnolence (15.3%), aggression (8.2%), decreased appetite (6.1%), and rhinitis (5.1%). Dizziness (13.2%), somnolence (11.6%), and aggression (6.6%) most often led to perampanel interruption/dose adjustment during the extension. SIGNIFICANCE Data demonstrated adjunctive perampanel treatment in adolescents with drug-resistant partial seizures produced better seizure control versus placebo, sustained seizure frequency improvements, and a generally favorable safety profile. Results were comparable to the overall study population. CLINICAL TRIAL REGISTRATION clinicaltrials.gov Identifiers: Study 304: NCT00699972; 305: NCT00699582; 306: NCT00700310; Study 307: NCT00735397.
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Affiliation(s)
- William Rosenfeld
- Comprehensive Epilepsy Care Center for Children and Adults, St Louis, MO, USA.
| | - Joan Conry
- Children's National Medical Center, Washington, DC, USA.
| | | | | | - Haichen Yang
- Eisai Neuroscience Product Creation Unit, Woodcliff Lake, NJ, USA.
| | - Randi Fain
- Eisai Medical and Scientific Affairs, Woodcliff Lake, NJ, USA.
| | - Betsy Williams
- Eisai Medical and Scientific Affairs, Woodcliff Lake, NJ, USA.
| | - Dinesh Kumar
- Eisai Neuroscience Product Creation Unit, Woodcliff Lake, NJ, USA.
| | - Jin Zhu
- Formerly Eisai Inc., Woodcliff Lake, NJ, USA.
| | - Antonio Laurenza
- Eisai Neuroscience Product Creation Unit, Woodcliff Lake, NJ, USA.
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13
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Zwart R, Sher E, Ping X, Jin X, Sims JR, Chappell AS, Gleason SD, Hahn PJ, Gardinier K, Gernert DL, Hobbs J, Smith JL, Valli SN, Witkin JM. Perampanel, an antagonist of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors, for the treatment of epilepsy: studies in human epileptic brain and nonepileptic brain and in rodent models. J Pharmacol Exp Ther 2014; 351:124-33. [PMID: 25027316 DOI: 10.1124/jpet.114.212779] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Perampanel [Fycompa, 2-(2-oxo-1-phenyl-5-pyridin-2-yl-1,2-dihydropyridin-3-yl)benzonitrile hydrate 4:3; Eisai Inc., Woodcliff Lake, NJ] is an AMPA (α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid) receptor antagonist used as an adjunctive treatment of partial-onset seizures. We asked whether perampanel has AMPA receptor antagonist activity in both the cerebral cortex and hippocampus associated with antiepileptic efficacy and also in the cerebellum associated with motor side effects in rodent and human brains. We also asked whether epileptic or nonepileptic human cortex is similarly responsive to AMPA receptor antagonism by perampanel. In rodent models, perampanel decreased epileptic-like activity in multiple seizure models. However, doses of perampanel that had anticonvulsant effects were within the same range as those engendering motor side effects. Perampanel inhibited native rat and human AMPA receptors from the hippocampus as well as the cerebellum that were reconstituted into Xenopus oocytes. In addition, with the same technique, we found that perampanel inhibited AMPA receptors from hippocampal tissue that had been removed from a patient who underwent surgical resection for refractory epilepsy. Perampanel inhibited AMPA receptor-mediated ion currents from all the tissues investigated with similar potency (IC50 values ranging from 2.6 to 7.0 μM). Cortical slices from the left temporal lobe derived from the same patient were studied in a 60-microelectrode array. Large field potentials were evoked on at least 45 channels of the array, and 10 μM perampanel decreased their amplitude and firing rate. Perampanel also produced a 33% reduction in the branching parameter, demonstrating the effects of perampanel at the network level. These data suggest that perampanel blocks AMPA receptors globally across the brain to account for both its antiepileptic and side-effect profile in rodents and epileptic patients.
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Affiliation(s)
- R Zwart
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.R.S., A.S.C., S.D.G., P.J.H., K.G., D.L.G., S.N.V., J.M.W.); Lilly Research Laboratories, Eli Lilly and Company, Windlesham, Surrey, United Kingdom (R.Z., E.S.); and Indiana University/Purdue University, Riley Hospital, Indianapolis, Indiana (X.P., X.J., J.H., J.L.S.)
| | - E Sher
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.R.S., A.S.C., S.D.G., P.J.H., K.G., D.L.G., S.N.V., J.M.W.); Lilly Research Laboratories, Eli Lilly and Company, Windlesham, Surrey, United Kingdom (R.Z., E.S.); and Indiana University/Purdue University, Riley Hospital, Indianapolis, Indiana (X.P., X.J., J.H., J.L.S.)
| | - X Ping
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.R.S., A.S.C., S.D.G., P.J.H., K.G., D.L.G., S.N.V., J.M.W.); Lilly Research Laboratories, Eli Lilly and Company, Windlesham, Surrey, United Kingdom (R.Z., E.S.); and Indiana University/Purdue University, Riley Hospital, Indianapolis, Indiana (X.P., X.J., J.H., J.L.S.)
| | - X Jin
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.R.S., A.S.C., S.D.G., P.J.H., K.G., D.L.G., S.N.V., J.M.W.); Lilly Research Laboratories, Eli Lilly and Company, Windlesham, Surrey, United Kingdom (R.Z., E.S.); and Indiana University/Purdue University, Riley Hospital, Indianapolis, Indiana (X.P., X.J., J.H., J.L.S.)
| | - J R Sims
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.R.S., A.S.C., S.D.G., P.J.H., K.G., D.L.G., S.N.V., J.M.W.); Lilly Research Laboratories, Eli Lilly and Company, Windlesham, Surrey, United Kingdom (R.Z., E.S.); and Indiana University/Purdue University, Riley Hospital, Indianapolis, Indiana (X.P., X.J., J.H., J.L.S.)
| | - A S Chappell
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.R.S., A.S.C., S.D.G., P.J.H., K.G., D.L.G., S.N.V., J.M.W.); Lilly Research Laboratories, Eli Lilly and Company, Windlesham, Surrey, United Kingdom (R.Z., E.S.); and Indiana University/Purdue University, Riley Hospital, Indianapolis, Indiana (X.P., X.J., J.H., J.L.S.)
| | - S D Gleason
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.R.S., A.S.C., S.D.G., P.J.H., K.G., D.L.G., S.N.V., J.M.W.); Lilly Research Laboratories, Eli Lilly and Company, Windlesham, Surrey, United Kingdom (R.Z., E.S.); and Indiana University/Purdue University, Riley Hospital, Indianapolis, Indiana (X.P., X.J., J.H., J.L.S.)
| | - P J Hahn
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.R.S., A.S.C., S.D.G., P.J.H., K.G., D.L.G., S.N.V., J.M.W.); Lilly Research Laboratories, Eli Lilly and Company, Windlesham, Surrey, United Kingdom (R.Z., E.S.); and Indiana University/Purdue University, Riley Hospital, Indianapolis, Indiana (X.P., X.J., J.H., J.L.S.)
| | - K Gardinier
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.R.S., A.S.C., S.D.G., P.J.H., K.G., D.L.G., S.N.V., J.M.W.); Lilly Research Laboratories, Eli Lilly and Company, Windlesham, Surrey, United Kingdom (R.Z., E.S.); and Indiana University/Purdue University, Riley Hospital, Indianapolis, Indiana (X.P., X.J., J.H., J.L.S.)
| | - D L Gernert
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.R.S., A.S.C., S.D.G., P.J.H., K.G., D.L.G., S.N.V., J.M.W.); Lilly Research Laboratories, Eli Lilly and Company, Windlesham, Surrey, United Kingdom (R.Z., E.S.); and Indiana University/Purdue University, Riley Hospital, Indianapolis, Indiana (X.P., X.J., J.H., J.L.S.)
| | - J Hobbs
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.R.S., A.S.C., S.D.G., P.J.H., K.G., D.L.G., S.N.V., J.M.W.); Lilly Research Laboratories, Eli Lilly and Company, Windlesham, Surrey, United Kingdom (R.Z., E.S.); and Indiana University/Purdue University, Riley Hospital, Indianapolis, Indiana (X.P., X.J., J.H., J.L.S.)
| | - J L Smith
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.R.S., A.S.C., S.D.G., P.J.H., K.G., D.L.G., S.N.V., J.M.W.); Lilly Research Laboratories, Eli Lilly and Company, Windlesham, Surrey, United Kingdom (R.Z., E.S.); and Indiana University/Purdue University, Riley Hospital, Indianapolis, Indiana (X.P., X.J., J.H., J.L.S.)
| | - S N Valli
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.R.S., A.S.C., S.D.G., P.J.H., K.G., D.L.G., S.N.V., J.M.W.); Lilly Research Laboratories, Eli Lilly and Company, Windlesham, Surrey, United Kingdom (R.Z., E.S.); and Indiana University/Purdue University, Riley Hospital, Indianapolis, Indiana (X.P., X.J., J.H., J.L.S.)
| | - J M Witkin
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.R.S., A.S.C., S.D.G., P.J.H., K.G., D.L.G., S.N.V., J.M.W.); Lilly Research Laboratories, Eli Lilly and Company, Windlesham, Surrey, United Kingdom (R.Z., E.S.); and Indiana University/Purdue University, Riley Hospital, Indianapolis, Indiana (X.P., X.J., J.H., J.L.S.)
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