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Effect of Number of Previous Antiseizure Medications on Efficacy and Tolerability of Adjunctive Brivaracetam for Uncontrolled Focal Seizures: Post Hoc Analysis

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Abstract
Introduction The aim was to evaluate the efficacy and tolerability of adjunctive brivaracetam (BRV) in adults with severely drug-resistant focal seizures versus adults with less drug-resistant disease. Methods Data were pooled from patients with focal seizures on 1-2 concomitant antiseizure medications (ASMs) randomized to BRV 50, 100, 200 mg/day, or placebo in 3 phase 3 trials (N01252 [NCT00490035], N01253 [NCT00464269], and N01358 [NCT01261325]) with a 12-week treatment period. Outcomes were assessed in patients with >= 5 and 0-4 previous ASMs (stopped before trial drug initiation). Results In >= 5 previous ASMs subgroup (BRV 50, 100, 200 mg/day: n = 26, n = 137, n = 120; placebo: n = 151), percentage reduction over placebo in 28-day adjusted focal seizure frequency was 13.0% for 50 mg/day (p = 0.38), 18.1% for 100 mg/day (p = 0.006), 19.8% for 200 mg/day (p = 0.004), and 17.0% for all BRV-treated patients (p = 0.001). The 50% responder rate was 26.9%, 29.9%, 30.0%, and 29.7% for BRV 50, 100, 200, and 50-200 mg/day, respectively (placebo: 13.2%); odds ratios versus placebo were statistically significant (p < 0.05) for BRV 100, 200, and 50-200 mg/day. In 0-4 previous ASMs subgroup (BRV 50, 100, 200 mg/day: n = 135, n = 195, n = 129; placebo: n = 267), all BRV dosages showed statistically significant (1) percentage reduction over placebo in 28-day adjusted focal seizure frequency (21.4-28.7%); (2) differences from placebo in median percentage reduction in 28-day adjusted focal seizure frequency from baseline (35.5-45.9%; placebo: 21.3%); and (3) odds ratios versus placebo (favoring BRV) for 50% responder rates. In BRV-treated patients, treatment-emergent adverse event (TEAE) incidence (73.8% [217/294] vs. 64.6% [329/509]) and discontinuation due to TEAEs (10.5% vs. 4.5%) were higher in the >= 5 versus 0-4 previous ASMs subgroup; serious TEAEs were rare in both subgroups (>= 5 previous ASMs: 3.1%; 0-4 previous ASMs: 2.9%). Conclusion Adjunctive BRV showed efficacy and was generally well tolerated in adults with focal seizures independent of the number of previous ASMs.
Author(s)
이상암Boeun HurCedric LaloyauxKyoung HeoSami ElmouftiSang-Kun LeeSung-Eun Kim
Issued Date
2021
Type
Article
Keyword
Anti-epileptic drugsAntiseizure medicationsBrivaracetamDrug-resistant epilepsyDrug-resistant focal seizuresEfficacyFocal epilepsyTolerability.
DOI
10.1007/s12325-021-01816-5
URI
https://oak.ulsan.ac.kr/handle/2021.oak/8170
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2544162435&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Effect%20of%20Number%20of%20Previous%20Antiseizure%20Medications%20on%20Efficacy%20and%20Tolerability%20of%20Adjunctive%20Brivaracetam%20for%20Uncontrolled%20Focal%20Seizures:%20Post%20Hoc%20Analysis&amp;offset=0&amp;pcAvailability=true
Publisher
ADVANCES IN THERAPY
Location
미국
Language
영어
ISSN
0741-238X
Citation Volume
38
Citation Number
7
Citation Start Page
4082
Citation End Page
4099
Appears in Collections:
Medicine > Medicine
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