Brivaracetam efficacy and tolerability in clinical practice: A UK-based retrospective multicenter service evaluation.
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.
['Adewusi|J|J|', 'Burness|C|C|', 'Ellawela|S|S|', 'Emsley|H|H|', 'Hughes|R|R|', 'Lawthom|C|C|', 'Maguire|M|M|', 'McLean|B|B|', 'Mohanraj|R|R|', 'Oto|M|M|', 'Singhal|S|S|', 'Reuber|M|M|']
D000293:Adolescent D000328:Adult D000368:Aged D000927:Anticonvulsants D015331:Cohort Studies D004828:Epilepsies, Partial D004829:Epilepsy, Generalized D005221:Fatigue D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D008875:Middle Aged D011760:Pyrrolidinones D012189:Retrospective Studies D012640:Seizures D016896:Treatment Outcome D006113:United Kingdom D055815:Young Adult
Brivaracetam Tolerability Epilepsy Levetiracetam Learning disability Seizure control