Academic Neurology Unit, University of Sheffield, UK.
The Walton Centre, NHS Foundation Trust, Liverpool, UK.
Epilepsy Behav. 2020 May;106:106967. doi: 10.1016/j.yebeh.2020.106967. Epub 2020 Mar 14.
This multicenter service evaluation explores the efficacy and tolerability of brivaracetam (BRV) in an unselected, consecutive population in 'real-life' clinical settings.
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).
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.
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.
本多中心服务评估在“真实生活”临床环境中，对未经选择的连续人群中布瓦西坦（BRV）的疗效和耐受性进行探索。
我们从 11 家英国医院和癫痫中心的患者病历中回顾性收集数据。纳入至少有 3 个月随访（FU）的连续使用 BRV 治疗的患者。除了报告整个队列的 BRV 有效性和耐受性外，我们还根据先前使用左乙拉西坦（LEV+与 LEV-）、合并学习障碍（LD+与 LD-）和癫痫综合征（局灶性与全面性癫痫）比较治疗结局。
共纳入 290 例（46%为男性，中位年龄：38 岁，范围：15-77 岁）患者，有≥3 个月 FU。BRV 暴露的中位时间为 12 个月（范围：1 天至 72 个月）。总体 BRV 保留率为 71.1%。56.1%的患者在发作频率类别（每日、每周、每月、每年发作）方面有所改善，23.1%的患者在这一指标上没有改善，20.8%的患者恶化。就发作频率而言，21%的患者发作减少≥50%，7.0%的患者完全无发作。107 例（36.9%）患者报告出现治疗相关不良事件（AE），但无严重 AE。最常见的 AE 是镇静/疲劳（18.3%）、情绪改变（9.0%）和易激惹/攻击性（4.8%）。LEV+与 LEV-亚组之间、全面性或局灶性癫痫患者之间，药物保留率、发作频率结局或 AE 无显著差异。虽然 LD+组中 15.5%的患者发作减少≥50%，但这一比例低于 LD-组。
这项“真实生活”评估表明，在高度耐药性癫痫患者中，BRV 可降低发作频率。BRV 可能是那些先前对 LEV 反应不佳或不耐受、有学习障碍、或（超适应证）患有全面性癫痫患者的有用治疗选择。
