PMID- 38158709
OWN - NLM
STAT- MEDLINE
DCOM- 20240319
LR  - 20240319
IS  - 1528-1167 (Electronic)
IS  - 0013-9580 (Linking)
VI  - 65
IP  - 3
DP  - 2024 Mar
TI  - Value of drug level concentrations of brivaracetam, lacosamide, and perampanel in 
      care of people with epilepsy.
PG  - 620-629
LID - 10.1111/epi.17873 [doi]
AB  - OBJECTIVE: The aim of this study was to determine whether clinical efficacy and 
      reported adverse effects (AEs) of the newer antiseizure medications (ASMs) 
      brivaracetam (BRV), lacosamide (LCM), and perampanel (PER) have been associated 
      with plasma levels of these ASMs. We also investigated whether plasma levels 
      outside the reference range has led to dose adjustments. METHODS: Plasma levels 
      of 300 people with epilepsy (PWE) seen at our tertiary epilepsy center were 
      determined by liquid chromatography-tandem mass spectrometry. PWE received BRV 
      (n = 100), LCM (n = 100), or PER (n = 100), in most cases in polytherapy. 
      Demographic and clinical data were retrospectively analyzed and related to plasma 
      levels. Clinical efficacy of BRV, LCM, or PER was assessed retrospectively by 
      comparing seizure frequency at the time of current blood draw with seizure 
      frequency at the time of first administration. AEs were also recorded and, if 
      reported, compared retrospectively with the time of first administration. 
      RESULTS: No significant associations were found between plasma levels of BRV, 
      LCM, or PER and seizure freedom (BRV, p = 1.000; LCM, p = .243; PER, p = .113) or 
      responder status (BRV, p = .118; LCM, p = .478; PER, p = .069) at presentation. 
      There was also no pattern between plasma levels and the occurrence of AEs. In the 
      majority of cases, drug levels outside the reference ranges have not led to 
      adjustments in the daily doses of BRV (93.5%), LCM (93.9%), or PER (89.1%). 
      SIGNIFICANCE: Plasma levels at a given time point did not allow conclusions to be 
      drawn about seizure control or the occurrence of AEs. Our findings indicate that 
      efficacy and tolerability cannot be predicted based on averaged data from a 
      single plasma measurement due to high interindividual variability. Instead, 
      individual reference values should be established when sufficient clinical data 
      are available, in line with the 2008 International League Against Epilepsy 
      position paper on therapeutic drug monitoring.
CI  - (c) 2023 The Authors. Epilepsia published by Wiley Periodicals LLC on behalf of 
      International League Against Epilepsy.
FAU - Hentschel, Matthias
AU  - Hentschel M
AUID- ORCID: 0009-0002-5852-0466
AD  - Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital 
      Bonn, Bonn, Germany.
FAU - Stoffel-Wagner, Birgit
AU  - Stoffel-Wagner B
AD  - Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital 
      Bonn, Bonn, Germany.
FAU - Surges, Rainer
AU  - Surges R
AD  - Department of Epileptology, University Hospital Bonn, Bonn, Germany.
FAU - von Wrede, Randi
AU  - von Wrede R
AUID- ORCID: 0000-0002-9430-5037
AD  - Department of Epileptology, University Hospital Bonn, Bonn, Germany.
FAU - Dolscheid-Pommerich, Ramona Christina
AU  - Dolscheid-Pommerich RC
AD  - Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital 
      Bonn, Bonn, Germany.
LA  - eng
PT  - Journal Article
DEP - 20240119
PL  - United States
TA  - Epilepsia
JT  - Epilepsia
JID - 2983306R
RN  - 563KS2PQY5 (Lacosamide)
RN  - H821664NPK (perampanel)
RN  - U863JGG2IA (brivaracetam)
RN  - 0 (Anticonvulsants)
RN  - 0 (Pyrrolidinones)
RN  - 0 (Nitriles)
RN  - 0 (Pyridones)
SB  - IM
MH  - Humans
MH  - Lacosamide/therapeutic use
MH  - *Anticonvulsants/adverse effects
MH  - Retrospective Studies
MH  - *Epilepsy/drug therapy/chemically induced
MH  - Pyrrolidinones/adverse effects
MH  - Seizures/drug therapy/chemically induced
MH  - Treatment Outcome
MH  - Drug Therapy, Combination
MH  - *Nitriles
MH  - *Pyridones
OTO - NOTNLM
OT  - antiseizure medication
OT  - brivaracetam
OT  - epilepsy
OT  - lacosamide
OT  - perampanel
OT  - reference range
OT  - therapeutic drug monitoring
EDAT- 2024/01/02 11:44
MHDA- 2024/03/19 06:43
CRDT- 2023/12/30 01:54
PHST- 2023/12/19 00:00 [revised]
PHST- 2023/08/25 00:00 [received]
PHST- 2023/12/19 00:00 [accepted]
PHST- 2024/03/19 06:43 [medline]
PHST- 2024/01/02 11:44 [pubmed]
PHST- 2023/12/30 01:54 [entrez]
AID - 10.1111/epi.17873 [doi]
PST - ppublish
SO  - Epilepsia. 2024 Mar;65(3):620-629. doi: 10.1111/epi.17873. Epub 2024 Jan 19.