Abstract
Objectives Assess the efficacy and tolerability of brivaracetam (BRI) in adult patients with epilepsy in a real-world setting.
Methods This multi-centre retrospective observational cohort study examined all adult patients commenced on BRI at 11 Australian epilepsy centres between May 2008 and November 2020. Primary outcomes were seizure response (≥ 50% reduction in frequency) and seizure freedom 12 months post BRI commencement. We compared incident (since last study time point) and continuous (since BRI commencement) outcome definitions, using three approaches to missing data (complete case analysis, CCA; last observation carried forward, LOCF; intention to treat, ITT). In addition, we examined individualised assessment waiting periods calculated using baseline seizure frequency.
Results Baseline and follow-up data was available for 229 patients. Mean age was 41.5 years (IQR 30, 50). Most had focal epilepsy (188/229, 82.1%). Median number of previous ASMs was 4 (IQR 2, 7), and concomitant ASMs 2 (IQR 2, 3). Twelve-month incident responder rate was 47.1% (95% CI 34.8, 59.6) using CCA, 39.7% (95% CI 33.4, 46.4) using LOCF, and 15.7% (95% CI 11.3, 21.1) using ITT. Twelve-month incident seizure freedom was 23.5% (95% CI 14.1, 35.4) using CCA, 24.5% (95% CI 19.0, 30.5) using LOCF, and 7.9% (95% CI 4.7, 12.1) using ITT. Outcomes were similar using continuous outcome definitions, and in the sub-group of patients who had completed individualised assessment waiting periods.
Conclusions Meaningful real-world responder and seizure freedom rates are still observed in this highly refractory population. Early BRI response appears to be maintained with minimal later relapse.
