Brivaracetam was approved for adjunctive treatment of partial epilepsy with focal and secondary generalised seizures by the EMEA in January 2016. Briveractam has s similar chemical structure then levetiracetam and a higher binding affinity to the SV2A receptor. A recent meta-analysis of brivaracetam included 6 RCTs in adult patients with drug refractory epilepsy(1). With the intention-to-treat 2399 participants were included, 1715 on brivaracetam, and 684 on placebo. The pooled RR for seizure freedom was 4.47 (2.00-11.75) and for the 50% responder 1.79 (1.51-2.12) respectively. Interestingly, a subgroup analysis of those participants on levetiracetam showed no significant in the 50% responder rate of add-on brivaracetam vs. placebo. The efficacy of brivaracetam was greater in levetiracetam naïve patients compared to those exposed before. The most frequent side-effects were under 5% and included irritability, fatigue, somnolence and dizziness. The effective dose range in these studies were between 20 and 200 mg.
Another small study of 29 patients investigated non psychotic behavioural adverse events (BAE) receiving levetiracetam, who switched to brivaracetam(2). Over 90% of patients had a meaningful reduction of BAE, 79% reported TEAE with one SAE (suicidal ideation and attempt) and 2 discontinuations.
In summary, brivaracetam is an efficacious new anti-epileptic drug. The side effect, particularly the BAE seem to be less frequent as on levetiracetam. Concomitant use of brivaracetam and levetiracetam is not of additional benefit.
1. Lattanzi S, Cagnetti C, Foschi N, Provinciali L, Silvestrini M. Brivaracetam add-on for refractory focal epilepsy: A systematic review and meta-analysis. Neurology. 2016 Apr 5;86(14):1344–52.
2. Yates SL, Fakhoury T, Liang W, Eckhardt K, Borghs S, D’Souza J. An open-label, prospective, exploratory study of patients with epilepsy switching from levetiracetam to brivaracetam. Epilepsy Behav EB. 2015 Nov;52(Pt A):165–8.