Brivaracetam 75mg tablets

ObjectiveAntiseizure medications (ASMs) are the cornerstone of epilepsy treatment. However, evidence on direct comparison of ASMs is lacking. This network meta-analysis evaluated the comparative efficacy and safety of approved and investigational add-on third-generation ASMs for focal epilepsy in adolescents and adults.MethodsData were retrieved through an extensive literature search of PubMed, Embase, Cochrane Library, and ClinicalTrial.gov databases from inception through August 2025. Findings were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline (CRD420251180027). Primary efficacy outcomes were ≥50 % and 100 % responder rates at 12-weeks maintenance duration. Secondary outcomes were corresponding responder rates at 8-weeks maintenance duration. Tolerability was assessed as retention rate. Treatment-emergent adverse events (TEAEs) and TEAEs leading to treatment discontinuation were the safety outcomes.ResultsThe literature search retrieved 345 studies, of which 35 studies were included. All ASMs showed significantly higher responder rates compared with placebo. Significantly higher 100 % responder rate was observed with cenobamate (CNB; 400mg/d: Risk ratio [RR] 15; 95 % CI, 7.0-39; 200mg/d: RR 8.7; 95 % CI, 3.9-22) at a maintenance duration of 12 weeks and 8 weeks (400mg/d: RR 15; 95 % CI, 7.0-41; 200mg/d: RR 8.6; 95 % CI, 4.0-24). All ASMs showed a patient retention rate comparable with placebo. For overall TEAEs, brivaracetam (BRV; 50mg/d) and BRV ranked the lowest for individual and pooled doses, respectively; placebo ranked the highest in both cases. For TEAEs leading to treatment discontinuation, CNB ranked lower than the placebo.SignificanceAll approved and investigational ASMs were effective add-on treatments for focal epilepsy, with CNB demonstrating the greatest likelihood of achieving seizure freedom.

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ObjectiveCognitive impairment is a common comorbidity in epilepsy, negatively affecting patients' quality of life. Although various treatments-antiepileptic drugs (AEDs), vagus nerve stimulation (VNS), and surgery-may influence cognition, comparative data on their effects on executive functions and memory remain limited. This systematic review aimed to evaluate studies assessing the impact of these treatments on executive functions and memory using the EpiTrack cognitive screening tool.MethodsA systematic search identified 1,008 publications, of which 35 full-text articles were reviewed. After applying inclusion criteria, seven studies were included, examining cognitive changes in patients undergoing various treatments.ResultsPerampanel and Cenobamate exhibited a neutral cognitive profile, with scores stable at "moderate impairment" (29.67-30.04). Lamotrigine and Levetiracetam demonstrated persistent severe impairment. Brivaracetam improved from severe to moderate impairment (not clinically significant). Only Topiramate showed a clinically significant decline (30.0 to 26.6). VNS therapy led to slight improvement over five years (severe to moderate impairment), while combined VNS + 1-2AEDs produced clinically meaningful gains. In contrast, VNS with 3-4 AEDs maintained severe impairment.ConclusionThis review underscores the importance of accurate cognitive assessment in epilepsy management, with a monitoring frequency of no more than every six months for patients receiving AED therapy.

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This study conducts a cost-effectiveness analysis of brivaracetam (BRV) compared to other 3rd-generation antiseizure medications (AEDs) for the treatment of pharmacoresistant focal-onset seizures in Jordan. A Markov model was constructed over a 2-years’ time horizon for a hypothetical cohort of focal-onset seizures patients. A cycle of 3-months was adopted in our economic evaluation (total cycles of 8 cycles). Four health states were defined: seizure free, partial responders (≥50% reduction in seizure frequency), non-responders, and discontinuation. In addition to BRV, 3 treatment comparators were included in this economic evaluation: eslicarbazepine (ESL), lacosamide (LCM), and perampanel (PER). Clinical data were retired from a previously published network meta-analysis of 65 randomized controlled trials. Cost inputs were obtained from the Jordan Food and Drug Administration and local healthcare providers. Incremental Cost-Effectiveness Ratio (ICER) was calculated using the percentage of complete response (CR) in the denominator. Probabilistic sensitivity analysis was conducted to assess the robustness of the study findings. BRV was associated with the highest gains in CR over all AEDs included in this economic evaluation. The 2-year cost of ESL is JOD 4139; LCM is JOD 3078; PER is JOD 5541; BRV is JOD 3925. The incremental gain in CR with BRV was higher by 29.0%, 30.9%, and 26.4% compared to ESL, LCM, and PER, respectively. Despite these higher gains in CR with BRV versus all other AEDs in this economic evaluation, it was associated with lower cost when compared to ESL and PER at saving ICER of -JOD 737 per 1% CR achieved and -JOD 6113 per 1% CR achieved, respectively. However, BRV was associated with the ICER of JOD 2744 per 1% of CR achieved compared with LCM. These estimates were confirmed by the probabilistic sensitivity analysis. Compared to ESL and PER, BRV was associated with cost-savings. Compared to LCM, the BRV was cost-effective at the World Health Organization recommended willingness-to-pay threshold of 3× of Jordanian gross domestic product per capita.

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