Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, Special Administrative Regions, China.
Epilepsia Open. 2024 Feb;9(1):345-354. doi: 10.1002/epi4.12882. Epub 2023 Dec 26.
The Prince of Wales Hospital (PWH) Real-world Analysis of People with Drug-Resistant Epilepsy (DRE) on PERampanel (WRAPPER) study assessed effectiveness and tolerability of adjunctive perampanel in people with DRE attending PWH.
This was a prospective single-center real-world observational study involving 70 people with DRE between July 2016 and June 2021. A post hoc analysis after the initial study period of 16 weeks assessed outcomes for an extended period up to 52 weeks.
After 16 weeks, median dose of perampanel was 2 mg (IQR 24 mg). 50% responder rates were 40.0%, 41.5%, and 48.7% at 16, 26, and 52 weeks. Seizure freedom was 12.9%, 20.7%, and 25.6% at 16, 26, and 52 weeks. Monthly seizure frequency reduced from 3.0 (IQR 3.0-6.6) at baseline to 2.0 (IQR 2.0-6.0, p = 0.005) at 16 weeks; 2.0 (IQR 2.0-5.0, p = 0.01) at 26 weeks; and 2.0 (IQR 0.0-4.0, p = 0.018) at 52 weeks. Older age predicted 50% responders (OR 1.08, 95% CI 1.01-1.14, p = 0.048). At 16 weeks, 51.4% (36/70) had treatment-emergent adverse effects (TEAEs). Most common was seizure exacerbation at 35.7% (25/70) followed by fatigue at 15.7% (11/70). NPI-12 and ZBI scores indicated no increase in neuropsychiatric symptoms on perampanel.
Low-dose 2-4 mg adjunctive perampanel for people with DRE conferred appreciable improvements in seizure reduction without significant neuropsychiatric adverse effects in the real-world setting at a tertiary center in Hong Kong and had better antiseizure effect with advancing age.
This real-world study from Hong Kong found low-dose perampanel was effective and tolerable for people with drug-resistant epilepsy. Furthermore, perampanel was also potentially more effective with advancing age.
威尔斯亲王医院耐药性癫痫患者（DRE）曲拉西泮真实世界分析（WRAPPER）研究评估了 DRE 患者在威尔斯亲王医院使用添加性拉西泮的有效性和耐受性。
这是一项前瞻性单中心真实世界观察性研究，涉及 2016 年 7 月至 2021 年 6 月期间的 70 名 DRE 患者。在最初的 16 周研究期后进行的事后分析评估了长达 52 周的扩展期的结果。
在 16 周后，拉西泮的中位剂量为 2 毫克（24 毫克的 IQR）。在 16、26 和 52 周时，50%的应答率分别为 40.0%、41.5%和 48.7%。癫痫无发作率分别为 12.9%、20.7%和 25.6%，在 16、26 和 52 周时。每月癫痫发作频率从基线时的 3.0（IQR 3.0-6.6）降至 16 周时的 2.0（IQR 2.0-6.0，p=0.005）；在 26 周时为 2.0（IQR 2.0-5.0，p=0.01）；在 52 周时为 2.0（IQR 0.0-4.0，p=0.018）。年龄较大预测 50%的应答者（OR 1.08，95%CI 1.01-1.14，p=0.048）。在 16 周时，51.4%（36/70）出现治疗相关不良事件（TEAEs）。最常见的是癫痫发作恶化，占 35.7%（25/70），其次是疲劳，占 15.7%（11/70）。NPI-12 和 ZBI 评分表明拉西泮没有增加神经精神症状。
在香港的一个三级中心的真实世界环境中，低剂量 2-4 毫克的辅助性拉西泮可显著减少癫痫发作，且没有明显的神经精神不良反应，在年龄较大的患者中，抗癫痫作用更好。
