2024 American Academy of Neurology Abstract Website

Vicente Villanueva¹, Wendyl D'Souza², Edward Faught³, Pavel Klein⁴, Markus Reuber⁵, Felix Rosenow⁶, Javier Salas-Puig⁷, Victor Soto Insuga⁸, Adam Strzelczyk⁶, Jerzy P. Szaflarski⁹, Herve Besson¹⁰, Dimitrios Bourikas¹⁰, Tony Daniels¹⁰, Florin Floricel¹⁰, David Friesen¹⁰, Cedric Laloyaux¹¹, Veronica Sendersky¹⁰, Bernhard J. Steinhoff¹²
¹Hospital Universitario y Politecnico La Fe, ²The University of Melbourne, ³Emory Epilepsy Center, Emory University School of Medicine, ⁴Mid-atlantic Epilepsy and Sleep Center, ⁵Sheffield Teaching Hospitals NHS Trust, The University of Sheffield, ⁶Epilepsy Center Frankfurt Rhine-Main, ⁷Universitari Vall d'Hebron, ⁸Hospital Universitario Infantil Nino Jesus, ⁹UAB Epilepsy Center, ¹⁰UCB Pharma, ¹¹UCBMedical Affairs Center of Expertise, UCB Pharma, ¹²University of Freiburg

Objective:

Assess effectiveness and tolerability of brivaracetam in epilepsy patients with cognitive or learning disability (CLD) or psychiatric comorbidities (PC) at baseline.

Background:

EXPERIENCE/EPD332 was a pooled analysis of retrospective cohorts of patients with epilepsy initiating brivaracetam in clinical practice.

Design/Methods:

Subgroup analysis of patients with CLD or PC. Outcomes: ≥50% seizure reduction from baseline and continuous seizure freedom (CSF; no seizures after baseline) and treatment-emergent adverse events (TEAEs) since prior visit at 12 months. Patients with missing data after brivaracetam discontinuation were considered not seizure free.

Results:

Analyses by CLD status included 1635 patients (403/1232 with/without CLD). Patients with vs without CLD were younger (96.3/89.3% <65 years), had higher median seizure frequency (7.7/4.0 seizures/28 days [n=342/1035]) and higher median number of prior antiseizure medications (7.0/4.0 [n=396/1215]) at index (date of brivaracetam initiation). In both subgroups, median brivaracetam dose at index was 100 mg/day (with/without CLD: n=395/1211). At 12 months, ≥50% seizure reduction was 35.6/37.4% (n=264/553) and CSF was 5.7/14.2% (n=318/788). Patients with/without CLD (n=283/942) had similar incidences of TEAEs (11.3/8.7%), psychiatric (3.5/2.2%), cognitive (1.1/0.8%) and behavioral TEAEs (1.8/0.3%). Brivaracetam discontinuations during study follow-up were 37.1/32.6% (n=402/1228).

Analyses by PC status included 1616 patients (605/1011 with/without PC). Baseline characteristics were generally similar between subgroups. In both subgroups, median brivaracetam dose at index was 100 mg/day (with/without PC: n=597/996). At 12 months, patients with/without PC had similar 50% seizure reduction (38.7/36.1% [n=310/493]) and CSF (13.7/10.4% [n=424/661]). Patients with/without PC (n=410/803) had similar incidences of TEAEs (10.0/8.8%), psychiatric (2.7/2.5%), cognitive (1.2/0.9%) and behavioral TEAEs (0.7/0.5%). Brivaracetam discontinuations during study follow-up were 30.7/35.4% (n=603/1008).

Conclusions:

In this large descriptive real-world analysis, brivaracetam was effective and well tolerated in adults with epilepsy and CLD or PC at baseline. Brivaracetam treatment did not appear to exacerbate CLD or PC, as shown by low incidences of psychiatric, cognitive, and behavioral TEAEs.