Tolerability of perampanel: A retrospective study at the department of psychiatry

• Published in: Epilepsy & behavior 2024-07, Vol.156, p.109797, Article 109797
• Main Authors: Matsuyama, Taiki, Horinouchi, Toru, Nakamura, Yuichi, Ishikawa, Shuhei, Hashimoto, Naoki, Kusumi, Ichiro
• Format: Article
• Language: English
• Subjects: Anti-seizure medication; Intellectual disability; Perampanel; Psychiatric adverse effects; Psychiatric comorbidity
• ISSN: 1525-5050; 1525-5069; 1525-5069
• DOI: 10.1016/j.yebeh.2024.109797

•The risk factors leading to perampanel discontinuation are not well understood.•Non-response, the occurrence of psychiatric adverse effects, the occurrence of common adverse effects, and psychiatric comorbidities were the main obstacles to perampanel treatment.•Consideration of factors contributing to perampanel discontinuation may assist in determining the indication for perampanel treatment. We aimed to identify factors that contribute to the discontinuation of perampanel. We retrospectively analyzed patients with epilepsy at the Department of Psychiatry, Hokkaido University Hospital. We evaluated the factors contributing to perampanel discontinuation as primary outcomes using Cox proportional hazards regression. Then, we explored the components contributing to the primary outcomes using logistic regression analysis. A total of 118 patients were included, 44.9% of whom discontinued participation, 22.0% had intellectual disability, and 23.7% had a psychiatric disorder other than intellectual disability. Adverse effects occurred in 65% of the patients, 23.7% had psychiatric adverse effects (PAE), and 49.2% had common adverse effects (CAE). The effect of PER to suppress seizures was confirmed in 65.3% of them. Discontinuation was influenced by non-response (Hazard Ratio (HR) 6.70, 95% Confidence Interval (CI) 3.42–13.1), the occurrence of PAE (HR 3.68, 95% CI 1.89–7.16), CAE (HR 1.90, 95% CI 1.06–3.41), and comorbid psychiatric disorders (HR 2.35, 95% CI 1.21–4.59). Moreover, comorbid intellectual disability correlated with a low risk of PAE (OR 0.19, 95% CI 0.04–0.89). The discontinuation of perampanel is influenced by poor efficacy and the occurrence of common/psychiatric adverse effects. The discontinuation of perampanel is influenced by poor efficacy and the occurrence of common/psychiatric adverse effects. Consideration of factors contributing to perampanel discontinuation may assist in determining the indication for perampanel treatment.