PMID- 32179501 OWN - NLM STAT- MEDLINE DCOM- 20210119 LR - 20210119 IS - 1525-5069 (Electronic) IS - 1525-5050 (Linking) VI - 106 DP - 2020 May TI - Brivaracetam efficacy and tolerability in clinical practice: A UK-based retrospective multicenter service evaluation. PG - 106967 LID - S1525-5050(20)30142-6 [pii] LID - 10.1016/j.yebeh.2020.106967 [doi] AB - PURPOSE: This multicenter service evaluation explores the efficacy and tolerability of brivaracetam (BRV) in an unselected, consecutive population in 'real-life' clinical settings. METHOD: We retrospectively collected data from patient records at 11 UK hospitals and epilepsy centers. Consecutive patients prescribed BRV with at least 3 months of follow-up (FU) were included. Apart from reporting effectiveness and tolerability of BRV across the whole cohort, we compared treatment outcomes depending on previous levetiracetam use (LEV+ versus LEV-), comorbid learning disability (LD+ versus LD-), and epilepsy syndrome (focal versus generalized epilepsy). RESULTS: Two hundred and ninety patients (46% male, median age: 38 years, range: 15 to 77) with >/=3 months of FU were included. The median duration of BRV exposure was 12 months (range: 1 day to 72 months). Overall BRV retention was 71.1%. While 56.1% of patients improved in terms of seizure frequency category (daily, weekly, monthly, yearly seizures), 23.1% did not improve on this measure and 20.8% deteriorated. In terms of seizure frequency, 21% of patients experienced a >/=50% reduction, with 7.0% of all patients becoming seizure-free. Treatment-emergent adverse events (AEs) were reported by 107 (36.9%) patients, but there were no serious AEs. The commonest AEs were sedation/fatigue (18.3%), mood changes (9.0%), and irritability/aggression (4.8%). There were no significant differences in drug retention, seizure frequency outcomes, or AEs between the LEV+ and LEV- subgroups, or between patients with generalized or focal epilepsies. Although 15.5% of patients in the LD+ group achieved a >/=50% reduction, this rate was lower than in the LD- group. CONCLUSIONS: This 'real-life' evaluation suggests that reductions in seizure frequency can be achieved with BRV in patients with highly refractory epilepsy. Brivaracetam may be a useful treatment option in patients who have previously failed to respond to or tolerate LEV, those with LD, or (off-label) those with generalized epilepsies. CI - Copyright (c) 2020. Published by Elsevier Inc. FAU - Adewusi, J AU - Adewusi J AD - Academic Neurology Unit, University of Sheffield, UK. Electronic address: jkadewusi1@sheffield.ac.uk. FAU - Burness, C AU - Burness C AD - The Walton Centre, NHS Foundation Trust, Liverpool, UK. Electronic address: christine.burness@thewaltoncentre.nhs.uk. FAU - Ellawela, S AU - Ellawela S AD - Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK. Electronic address: shan.ellawela@nuth.nhs.uk. FAU - Emsley, H AU - Emsley H AD - Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK. Electronic address: Hedley.Emsley@lthtr.nhs.uk. FAU - Hughes, R AU - Hughes R AD - Manchester University NHS Foundation Trust, UK. Electronic address: rhiannon.hughes@mft.nhs.uk. FAU - Lawthom, C AU - Lawthom C AD - Royal Gwent Hospital, Newport, UK. Electronic address: charlotte.lawthom2@wales.nhs.uk. FAU - Maguire, M AU - Maguire M AD - Leeds Teaching Hospitals NHS Foundation Trust, Leeds, UK. Electronic address: melissamaguire@nhs.net. FAU - McLean, B AU - McLean B AD - Royal Cornwall Hospital NHS Trust, Truro, UK. Electronic address: brendan.mclean@nhs.net. FAU - Mohanraj, R AU - Mohanraj R AD - Salford Royal NHS Foundation Trust, Manchester, UK. Electronic address: Rajiv.Mohanraj@srft.nhs.uk. FAU - Oto, M AU - Oto M AD - William Quarriers Epilepsy Centre, Glasgow, UK. FAU - Singhal, S AU - Singhal S AD - Nottingham University Hospitals NHS Trust, Nottingham, UK. Electronic address: sumeet.singhal@nuh.nhs.uk. FAU - Reuber, M AU - Reuber M AD - Academic Neurology Unit, University of Sheffield, UK. Electronic address: markus.reuber@sth.nhs.uk. LA - eng PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't DEP - 20200314 PL - United States TA - Epilepsy Behav JT - Epilepsy & behavior : E&B JID - 100892858 RN - 0 (Anticonvulsants) RN - 0 (Pyrrolidinones) RN - U863JGG2IA (brivaracetam) SB - IM MH - Adolescent MH - Adult MH - Aged MH - Anticonvulsants/adverse effects/*therapeutic use MH - Cohort Studies MH - Epilepsies, Partial/*drug therapy/*epidemiology MH - Epilepsy, Generalized/*drug therapy/*epidemiology MH - Fatigue/chemically induced MH - Female MH - Follow-Up Studies MH - Humans MH - Male MH - Middle Aged MH - Pyrrolidinones/adverse effects/*therapeutic use MH - Retrospective Studies MH - Seizures/drug therapy/epidemiology MH - Treatment Outcome MH - United Kingdom/epidemiology MH - Young Adult OTO - NOTNLM OT - Brivaracetam OT - Epilepsy OT - Learning disability OT - Levetiracetam OT - Seizure control OT - Tolerability COIS- Declaration of competing interest UCB supported this investigator-led project by funding the salary costs of the researcher responsible for data collection. UCB had no influence on the data analysis or the preparation of this manuscript. MR has received speaker's fees from UCB, Eisai, and LivaNova. EDAT- 2020/03/18 06:00 MHDA- 2021/01/20 06:00 CRDT- 2020/03/18 06:00 PHST- 2019/11/22 00:00 [received] PHST- 2020/01/14 00:00 [revised] PHST- 2020/02/01 00:00 [accepted] PHST- 2020/03/18 06:00 [pubmed] PHST- 2021/01/20 06:00 [medline] PHST- 2020/03/18 06:00 [entrez] AID - S1525-5050(20)30142-6 [pii] AID - 10.1016/j.yebeh.2020.106967 [doi] PST - ppublish SO - Epilepsy Behav. 2020 May;106:106967. doi: 10.1016/j.yebeh.2020.106967. Epub 2020 Mar 14.