Tolerability, efficacy and retention rate of Brivaracetam in patients previously treated with Levetiracetam: A monocenter retrospective outcome analysis

Abstract

PurposeTo determine the potential for improvement of tolerability and efficacy by the use of Brivaracetam (BRV) in patients previously treated with Levetiracetam (LEV). MethodsWe retrospectively analyzed data from patients treated with BRV at the Freiburg Epilepsy Center. Results102 patients with a minimum follow up of 6 months were included. The mean duration of treatment was 301.6 (± 156.8) days. 60 patients underwent an overnight switch from LEV to BRV, 42 patients have had LEV at some time in the past.Out of 46 patients with a quantifiable seizure baseline and follow-up of 6 months 10 patients (21.7%) had an increase in seizure frequency, 15 (32.6%) were 50%-responders, and 10 patients (21.7%) became newly seizure-free. Patients with an overnight switch from LEV to BRV who had a reduction in seizure frequency had the highest dose ratio of the final BRV dose to LEV (1:10.1) and the biggest difference between the starting and final dose of BRV, suggesting that previously seizure control was limited by the tolerated LEV dosage. The retention rate after 6 months was 80.4%.28 out of 49 (57.1%) patients directly switched from LEV to BRV because of psychiatric side effects reported an improved tolerability. 10 out of 42 (23.8%) patients not directly switched but with a history of LEV use had predominantly psychiatric side effects during BRV treatment. ConclusionOverall, intolerability or ineffectiveness of prior treatment with LEV seems not to preclude a good response to BRV. BRV was substantially better tolerated than LEV.