A brief review on efficacy and safety of brivaracetam in the management of partial onset epilepsy

Abstract

Brivaracetam, a propyl analog of levetiracetam is a new Antiepileptic Drug (AED), and the first selective ligand that binds to synaptic vesicle protein 2A (SV2A). Brivaracetam has 15–30 times greater affinity for SV2A and faster Blood-Brain Barrier permeability. This review examines the use of brivaracetam as add-on (50–200 mg/day) therapy for partial onset epilepsy with particular emphasis on its early onset of action, long-term efficacy, and safety profile. When initiating treatment with brivaracetam, gradual dose escalation is not required, and right therapeutic dose can be administered on first day itself. In pooled analysis of three phase-3 studies, early ≥50% responder rate (on day 1) was found across all brivaracetam treatment groups i.e. 15.5%, 18.1%, 19.4%, for 50, 100, 200 mg/day, respectively. In 11-year, follow-up trial, brivaracetam showed 50% responder rate as 55.6% which increased by exposure through 3 years and remained consistent through 9 years. Seizure freedom rates were 30.3% at 6 months and 20.3% at 12 months. Another long-term follow-up study involving 2,051 patients also reported increased ≥50% seizure reduction with brivaracetam in partial onset seizure from baseline over 5 years, 71.0% (at 58–60 months). In addition, brivaracetam demonstrated a favorable safety profile with minimal drug-drug interactions, lesser incidence of behavioral and psychiatric adverse effects. Brivaracetam also demonstrates improvement in cognitive profile and executive functions with reduced anxiety and improvement in quality of life in patient with epilepsy.