July 21, 2020

Treatment Comparison of Perampanel (Fycompa®) Versus Brivaracetam (Briviact®) as Add-On Therapy for Epilepsy

Abstract, published in Epilepsy Research

Purpose: To date, there has not been a single randomized controlled trial (RCT) conducted to directly compare the efficacy and safety of perampanel to brivaracetam in the add-on treatment of focal-onset seizures. Focal seizures are those that begin in a single area of the brain, which can then spread to the rest of the brain (secondarily generalization) and often be accompanied by violent convulsions (tonic-clonic).

Results: Eight RCTs (four comparing perampanel to placebo and four comparing brivaracetam to placebo) were included. For patients taking concomitant levetiracetam (Keppra®), which is chemically similar to brivaracetam, perampanel showed a significantly better responder rate compared to brivaracetam. For patients who had previously, or never, taken levetiracetam, there was no difference in the responder rate. In the overall population, both perampanel and brivaracetam were more effective than placebo in terms of responder rate, seizure freedom, and secondarily generalized tonic-clonic seizure responder rate; however, for these outcomes, no evidence of a difference between perampanel and brivaracetam was found. Patients taking brivaracetam showed significantly less dizziness compared to patients taking perampanel. No differences for any other safety outcome were found.

Conclusions: Perampanel and brivaracetam are effective for the add-on treatment of focal-onset seizures and display similar adverse event profiles. Perampanel demonstrated an improved focal-onset seizure responder rate compared to brivaracetam in patients taking concomitant levetiracetam. This may be due to the similarity in the mechanism of action between brivaracetam and levetiracetam.

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