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Villanueva V, Rodriguez-Osorio X, Juiz-Fernández Á, Sayas D, Hampel K, Castillo A, Montoya J, Garcés M, Campos D, Rubio-Nazábal E, Fernández-Cabrera A, Gifreu A, Santamarina E, Hernández Pérez G, Falip M, Parejo-Carbonell B, García-Morales I, Martínez AB, Massot M, Asensio M, Giménez J, Guillén V, Ruiz-Giménez J, Chavarria B, Rocamora R, Escalza I. Real-life evidence about the use of intravenous brivaracetam in urgent seizures: The BRIV-IV study. Epilepsy Behav 2023; 147:109384. [PMID: 37634373 DOI: 10.1016/j.yebeh.2023.109384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE Urgent seizures are a medical emergency for which new therapies are still needed. This study evaluated the use of intravenous brivaracetam (IV-BRV) in an emergency setting in clinical practice. METHODS BRIV-IV was a retrospective, multicenter, observational study. It included patients ≥18 years old who were diagnosed with urgent seizures (including status epilepticus (SE), acute repetitive seizures, and high-risk seizures) and who were treated with IV-BRV according to clinical practice in 14 hospital centers. Information was extracted from clinical charts and included in an electronic database. Primary effectiveness endpoints included the rate of IV-BRV responder patients, the rate of patients with a sustained response without seizure relapse in 12 h, and the time between IV-BRV administration and clinical response. Primary safety endpoints were comprised the percentage of patients with adverse events and those with adverse events leading to discontinuation. RESULTS A total of 156 patients were included in this study. The mean age was 57.7 ± 21.5 years old with a prior diagnosis of epilepsy for 57.1% of patients. The most frequent etiologies were brain tumor-related (18.1%) and vascular (11.2%) epilepsy. SE was diagnosed in 55.3% of patients. The median time from urgent seizure onset to IV treatment administration was 60.0 min (range: 15.0-360.0), and the median time from IV treatment to IV-BRV was 90.0 min (range: 30.0-2400.0). Regarding dosage, the mean bolus infusion was 163.0 ± 73.0 mg and the mean daily dosage was 195.0 ± 87.0 mg. A total of 77.6% of patients responded to IV-BRV (66.3% with SE vs. 91% other urgent seizures) with a median response time of 30.0 min (range: 10.0-60.0). A sustained response was achieved in 62.8% of patients. However, adverse events were reported in 14.7%, which were predominantly somnolence and fatigue, with 4.5% leading to discontinuation. Eighty-six percent of patients were discharged with oral brivaracetam. CONCLUSION IV-BRV in emergency settings was effective, and tolerability was good for most patients. However, a larger series is needed to confirm the outcomes.
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Affiliation(s)
- Vicente Villanueva
- Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | | | | | - Debora Sayas
- Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Kevin Hampel
- Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Javier Montoya
- Consorcio Hospital General Universitario, Valencia, Spain
| | - Mercedes Garcés
- Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Dulce Campos
- Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | | | | | | | | | | | - Mercé Falip
- Hospital Universitario Bellvitge, Barcelona, Spain
| | | | | | | | | | | | - Juana Giménez
- Hospital General Universitario Dr Balmis, Alicante, Spain
| | - Virginia Guillén
- Hospital General Universitario Virgen de las Nieves, Granada, Spain
| | | | - Beatriz Chavarria
- Member of ERN EPICARE, Hospital Universitario del Mar, Barcelona, Spain
| | - Rodrigo Rocamora
- Member of ERN EPICARE, Hospital Universitario del Mar, Barcelona, Spain
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