PMID- 34951748
OWN - NLM
STAT- MEDLINE
DCOM- 20220603
LR  - 20220716
IS  - 2470-9239 (Electronic)
IS  - 2470-9239 (Linking)
VI  - 7
IP  - 2
DP  - 2022 Jun
TI  - The efficacy and safety of adjunctive perampanel for the treatment of refractory 
      focal-onset seizures in patients with epilepsy: A meta-analysis.
PG  - 271-279
LID - 10.1002/epi4.12574 [doi]
AB  - OBJECTIVE: The last decade has seen an increase in the use of anti-seizure 
      medications (ASMs); however, the burden of treating drug-resistant epilepsy has 
      not fallen. We performed this meta-analysis to evaluate the optimal dose of 
      Perampanel (PER) as a new adjunctive treatment for drug-resistant seizures. 
      METHODS: We searched for studies published from inception to February 1, 2021 
      from PubMed, Central Register of Controlled Trials (CENTRAL), and ScienceDirect. 
      Research characteristics, patients' characteristics, and treatment regimen, 
      concomitant ASMs, clinical outcomes were extracted. The practical outcome 
      included a reduction in seizures frequency >/=50%, >/=75%, and >/=100% from baseline 
      convulsive seizure frequency, and the safety outcome included the proportion of 
      drug withdrawal and adverse reactions. Odds ratios (OR) for 95% confidence 
      intervals (95% CI) were estimated by the inverse variance method. RESULTS: Four 
      trials which enrolled 2187 participants (1569 in the PER group and 618 in the 
      placebo group) were included. Results showed that 8 or 12 mg per day had the best 
      effect on all three outcomes, with no significant difference between 8 and 12 mg 
      per day (>/=50% reduction, 35.5% vs 36.1%, P = .84; >/=75% reduction, 17.8% vs 19.1%, 
      P = .64; seizure-free, 3.5% vs 3.7%, P = .85). In addition, 12-mg PER compared to 
      8 mg had a higher proportion of trial withdrawal (8.7% vs 17.0%; P < .00001) and 
      treatment-emergent adverse event (TEAE) resulting in dose 
      reduction/discontinuation (18.5% vs 32.0%; P < .00001). The adverse events (AEs) 
      significantly associated with adjunctive PER were dizziness, somnolence, fatigue, 
      and irritability. SIGNIFICANCE: Adjunctive treatment of PER was associated with a 
      more significant reduction in the frequency of seizures in patients with 
      refractory epilepsy than placebo, but with a higher frequency of AEs. PER at a 
      daily dose of 8 mg appears to have the best ratio between efficacy and tolerance 
      in most study participants.
CI  - (c) 2021 The Authors. Epilepsia Open published by Wiley Periodicals LLC on behalf 
      of International League Against Epilepsy.
FAU - Li, Yiming
AU  - Li Y
AUID- ORCID: 0000-0002-2022-6811
AD  - West China Clinical Medical School, West China Hospital, Sichuan University, 
      Chengdu, China.
FAU - Zeng, Ya
AU  - Zeng Y
AUID- ORCID: 0000-0001-8379-9003
AD  - Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China.
FAU - Mu, Jie
AU  - Mu J
AUID- ORCID: 0000-0002-9773-3838
AD  - Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
FAU - Zhou, Dong
AU  - Zhou D
AUID- ORCID: 0000-0001-7101-4125
AD  - Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20220202
PL  - United States
TA  - Epilepsia Open
JT  - Epilepsia open
JID - 101692036
RN  - 0 (Anticonvulsants)
RN  - 0 (Nitriles)
RN  - 0 (Pyridones)
RN  - H821664NPK (perampanel)
SB  - IM
MH  - Anticonvulsants
MH  - *Drug Resistant Epilepsy/drug therapy
MH  - *Epilepsy/drug therapy
MH  - Humans
MH  - Nitriles
MH  - Pyridones
MH  - Seizures/drug therapy
MH  - Treatment Outcome
PMC - PMC9159293
OTO - NOTNLM
OT  - efficacy
OT  - perampanel
OT  - refractory focal-onset seizures
OT  - safety
COIS- Neither of the authors has any conflict of interest to disclose. We confirm that 
      we have read the Journal's position on issues involved in ethical publication and 
      affirm that this report is consistent with those guidelines.
EDAT- 2021/12/25 06:00
MHDA- 2022/06/07 06:00
PMCR- 2022/02/02
CRDT- 2021/12/24 12:15
PHST- 2021/11/17 00:00 [revised]
PHST- 2021/08/23 00:00 [received]
PHST- 2021/11/17 00:00 [accepted]
PHST- 2021/12/25 06:00 [pubmed]
PHST- 2022/06/07 06:00 [medline]
PHST- 2021/12/24 12:15 [entrez]
PHST- 2022/02/02 00:00 [pmc-release]
AID - EPI412574 [pii]
AID - 10.1002/epi4.12574 [doi]
PST - ppublish
SO  - Epilepsia Open. 2022 Jun;7(2):271-279. doi: 10.1002/epi4.12574. Epub 2022 Feb 2.