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Brivaracetam zur Zusatztherapie bei fokalen Epilepsien

Brivaracetam for add-on treatment in focal epilepsy

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Zusammenfassung

Brivaracetam ist das neueste zugelassene Antiepileptikum zur Zusatztherapie bei fokalen Epilepsien und besitzt eine hohe Affinität als SV2A-Ligand. Diese Übersichtsarbeit fasst die Daten aus den Zulassungsstudien zusammen, in denen mehr als 2000 Patienten Brivaracetam erhielten. Eine signifikante mediane Anfallsreduktion von 30,5–53,1 % für 50 mg/Tag, 32,5–37,2 % für 100 mg/Tag und 35,6 % für 200 mg/Tag konnte nachgewiesen werden. Insgesamt war Brivaracetam gut verträglich, wobei Fatigue, Schwindel und Somnolenz zu den hauptsächlich auftretenden unerwünschten Ereignissen gehören. Ein unmittelbarer Wechsel von Levetiracetam auf Brivaracetam in einem Umstellungsverhältnis zwischen 10:1 bis 15:1 scheint möglich und könnte verhaltensbezogene Nebenwirkungen, die durch Levetiracetam ausgelöst wurden, vermindern. Eine zügige Permeabilität ins Hirngewebe und ein schneller Wirkungseintritt im Vergleich zu Levetiracetam legen nahe, dass Brivaracetam in der Notfallsituation nützlich sein könnte.

Abstract

Brivaracetam is the latest antiepileptic drug to be approved for adjunctive therapy in focal epilepsy and has a high affinity as a SV2A ligand. The aim of this review article is to summarize the data from the pivotal studies in which more than 2000 patients received brivaracetam. A significant median reduction in seizures from 30.5 % to 53.1 % for 50 mg/day, from 32.5 % to 37.2 % for 100 mg/day and 35.6 % for 200 mg/day could be demonstrated. Overall brivaracetam appears to be well-tolerated, with fatigue, dizziness and somnolence being the main adverse side effects. An immediate change from levetiracetam to brivaracetam at a conversion ratio of 10:1 to 15:1 seems feasible and could alleviate behavioral side effects related to treatment with levetiracetam. A swift permeability into brain tissue and a faster onset of action compared to levetiracetam suggest that brivaracetam could be useful in emergency situations.

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Authors and Affiliations

  1. Epilepsiezentrum Frankfurt Rhein-Main, Klinik für Neurologie, J.W. Goethe-Universität, Frankfurt am Main, Deutschland

    A. Strzelczyk MHBA, I. Steinig, K. M. Klein, L. M. Willems, F. Rosenow & S. Bauer

  2. Epilepsiezentrum Hessen, Klinik für Neurologie, Philipps-Universität, Marburg, Deutschland

    A. Strzelczyk MHBA, K. M. Klein, S. Knake, F. Rosenow & S. Bauer

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Correspondence to A. Strzelczyk MHBA.

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Interessenkonflikt

I. Steinig und S. Bauer geben an, dass kein Interessenkonflikt besteht. A. Strzelczyk erhielt Beratungs-, Referentenhonorare und/oder Unterstützung für Forschungsvorhaben von Bayer HealthCare, Boehringer Ingelheim, Desitin Arzneimittel, Eisai, Pfizer, Sage Therapeutics und UCB Pharma. K.M. Klein erhielt Referentenhonorare von UCB Pharma, Novartis Pharma AG and Eisai. L. Willems berichtet über Reisekostenerstattung von Eisai. S. Knake erhielt Beratungs- und Referentenhonorare von Desitin und UCB Pharma. F. Rosenow erhielt Beratungshonorare von GlaxoSmithKline, Eisai, UCB Pharma, Shire, Sandoz und Pfizer. Er erhielt Referentenhonorare von UCB Pharma, GlaxoSmithKline, Eisai, Hexal, Desitin, Medtronic und Zuwendungen für Weiterbildungsveranstaltungen von Nihon-Kohden, UCB Pharma, Medtronics, Cyberonics und Cerbomed.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Strzelczyk, A., Steinig, I., Klein, K.M. et al. Brivaracetam zur Zusatztherapie bei fokalen Epilepsien. Nervenarzt 87, 1086–1093 (2016). https://doi.org/10.1007/s00115-016-0163-4

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