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

Abstract

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. Data were pooled from patients with focal seizures on 1-2 concomitant antiseizure medications (ASMs) randomized to BRV 50, 100, 200mg/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). In≥5 previous ASMs subgroup (BRV 50, 100, 200mg/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 50mg/day (p=0.38), 18.1% for 100mg/day (p=0.006), 19.8% for 200mg/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 50-200mg/day, respectively (placebo: 13.2%); odds ratios versus placebo were statistically significant (p<0.05) for BRV 100, 200, and 50-200mg/day. In 0-4 previous ASMs subgroup (BRV 50, 100, 200mg/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 inthe ≥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%). Adjunctive BRV showed efficacy and was generally well tolerated in adults with focal seizures independent of the number of previous ASMs.