Perampanel effectiveness and safety as early add-on treatment for focal-onset seizures: PEREAGAL study

• Published in: Epilepsy research 2021-05, Vol.172, p.106570-106570, Article 106570
• Main Authors: Rodríguez-Osorio, X., Lema-Facal, T., Rubio-Nazábal, E., Castro-Vilanova, M.D., Pato-Pato, A., Abella-Corral, J., Corredera, E., López-Ferreiro, A., Puy-Núñez, A., López-González, F.J.
• Format: Article
• Language: English
• Subjects: Anticonvulsants - adverse effects; Drug Therapy, Combination; Early-add on; Focal to bilateral tonic-clonic seizures; Focal-onset seizures; Humans; Nitriles; Perampanel; Pyridones - adverse effects; Rational polytherapy; Refractory epilepsy; Retrospective Studies; Seizures - drug therapy; Treatment Outcome
• ISSN: 0920-1211; 1872-6844
• DOI: 10.1016/j.eplepsyres.2021.106570

•PER is an effective and safe early add-on therapeutic for patients with FOS.•PER is particularly effective at reducing FBTCS.•The response rate is higher when PER is administered as an early add-on.•Retention rate is high after twelve months of observation.•Irritability was the main AE associated with treatment discontinuation. Perampanel (PER) is an effective adjunctive therapy for controlling focal-onset seizures (FOS), but few studies have examined its effects as an early add-on for the treatment of FOS in daily clinical practice. Our retrospective, multicenter, observational study evaluated the effectiveness and safety of PER as an early add-on in 77 patients with FOS, with and without focal to bilateral tonic-clonic seizures (FBTCS) after 3, 6 and 12 months in a real-world setting. After 12 months of treatment (median dose 6 [4,8] mg/day), the retention rate was 79.2 % and 60 % of patients (39/65) experienced a ≥50 % reduction in seizure frequency relative to baseline. The seizure‐free rate was 38.5 % for all seizures (25/65) and 60 % for FBTCS (12/20). The responder rate at 12 months was significantly higher when PER was given with one concomitant AED (72.2 %) compared to when PER was given with two concomitant AEDs (44.8 %). Drug-related adverse events (AEs) were reported in 40.3 % of patients, most of them being mild (64.2 %). Twelve patients (15.6 %) discontinued treatment because of AEs. PER is an effective and safe early add-on for patients with refractory FOS, especially for those with FBTCS.