Treatment Outcomes During Brivaracetam Treatment by Seizure Freedom Status at Baseline: Post hoc Analysis of a Real-world, US Study
Hina Dave1, Jacqueline A. French2, Heidi Henninger3, Hamada Hamid Altalib4, Roger Porter5, Michael Gelfand5, Melinda S. Martin6, Prashant Dongre6, Sami Elmoufti6, Anne-Liv Schulz6, Svetlana Dimova6, Michael R. Sperling7
1University of Texas Southwestern Medical Center, 2NYU Comprehensive Epilepsy Center, 3Maine Medical Center, 4Yale School of Medicine, 5University of Pennsylvania, 6UCB Pharma, 7Thomas Jefferson University
Objective:

Examine the relationship between baseline seizure control as well as clinical characteristics and outcomes on brivaracetam (BRV).

Background:
EP0088 (Dave H, et al. AES 2021; abstract 2.203) assessed clinical utility of BRV by examining 6- and 12-month retention after BRV initiation to provide an overall assessment of efficacy and tolerability.
Design/Methods:
Noninterventional, prospective study included patients aged ≥16 years, with history of focal seizures and lifetime history/current use of ≥1 of 4 common antiseizure medications (ASMs). Post hoc analyses were performed on subgroups seizure free (SF) and not SF (nSF) during 6-month retrospective baseline, and patients who were or were not ≥6 months SF at any time during BRV treatment
Results:

250/254 (98.4%) patients initiating BRV had baseline seizure frequency data (SF n=41; nSF n=209). Patients SF/nSF during baseline had generally similar 6- and 12-month BRV retention (6-month: 68.3%/65.1%; 12-month: 63.4%/56.9%) and overall tolerability (incidence of treatment-emergent adverse events [TEAEs]: 48.8%/49.8%). Compared with nSF, SF during baseline subgroup was: older, had fewer historical/lifetime ASMs, initiated BRV mainly due to behavioral AEs/other ASM intolerances, more commonly taking levetiracetam at BRV initiation. Main reason for BRV initiation in nSF subgroup was lack of current ASM efficacy. 21/41 (51.2%) patients SF at baseline were SF for ≥6 months during BRV treatment and had higher 12-month retention (90.5%) vs those nSF for ≥6 months (n=20; 35.0%). Patients nSF at baseline who became SF for any ≥6 months during BRV treatment (36/209; 17.2%) had: fewer historical/lifetime ASMs, higher 12-month retention (100% vs 48.0%), lower incidence of TEAEs/discontinuation due to TEAEs vs patients nSF for ≥6 months. In patients SF at baseline taking levetiracetam (n=29), levetiracetam discontinuation status did not affect SF during BRV treatment.

Conclusions:

BRV showed good retention and tolerability, which were similar in patients irrespective of seizure control prior to BRV initiation.

10.1212/WNL.0000000000201879