Tolerability, efficacy and retention rate of Brivaracetam in patients previously treated with Levetiracetam: A monocenter retrospective outcome analysis.

Purpose: To determine the potential for improvement of tolerability and efficacy by the use of Brivaracetam (BRV) in patients previously treated with Levetiracetam (LEV).

Methods: We retrospectively analyzed data from patients treated with BRV at the Freiburg Epilepsy Center.

Results: 102 patients with a minimum follow up of 6 months were included. The mean duration of treatment was 301.6 (± 156.8) days. 60 patients underwent an overnight switch from LEV to BRV, 42 patients have had LEV at some time in the past. Out of 46 patients with a quantifiable seizure baseline and follow-up of 6 months 10 patients (21.7%) had an increase in seizure frequency, 15 (32.6%) were 50%-responders, and 10 patients (21.7%) became newly seizure-free. Patients with an overnight switch from LEV to BRV who had a reduction in seizure frequency had the highest dose ratio of the final BRV dose to LEV (1:10.1) and the biggest difference between the starting and final dose of BRV, suggesting that previously seizure control was limited by the tolerated LEV dosage. The retention rate after 6 months was 80.4%. 28 out of 49 (57.1%) patients directly switched from LEV to BRV because of psychiatric side effects reported an improved tolerability. 10 out of 42 (23.8%) patients not directly switched but with a history of LEV use had predominantly psychiatric side effects during BRV treatment.

Conclusion: Overall, intolerability or ineffectiveness of prior treatment with LEV seems not to preclude a good response to BRV. BRV was substantially better tolerated than LEV.