Transitioning from Levetiracetam to Brivaracetam in Veterans with Medically Refractory Epilepsy
Abstract number :
3.424
Submission category :
7. Anti-seizure Medications / 7D. Drug Side Effects
Year :
2024
Submission ID :
16
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Caroline Grabowski, PharmD, BCPS – VA Greater Los Angeles Healthcare System
Presenting Author: Gayane Kechechyan, PharmD – VA Greater Los Angeles Healthcare System
Christine Phan, PharmD – VA Greater Los Angeles Healthcare System
Jin Suh, PharmD, BCPS – VA Greater Los Angeles Healthcare System
Jennifer Nguyen, PharmD – VA Greater Los Angeles Healthcare System
Sunita Dergalust, PharmD, BCPS – VA Greater Los Angeles Healthcare System
Rationale: Behavioral adverse effects (BAEs) are associated with several anti-seizure medications (ASMs) and include symptoms such as depression, nervousness, anxiety, hostility/aggression, and emotional lability. These BAEs can be dose limiting and affect the patient’s quality of life. In adult populations, the incidence of BAEs in patients on levetiracetam (LEV) is estimated at 13.3%, and hypothesized to be associated with LEV’s inhibitory activity on the AMPA receptors.1 Brivaracetam (BRV) is an ASM with a similar mechanism to LEV but without effect on the AMPA receptors. Several small studies have supported evidence that switching to BRV can decrease the incidence of BAEs.2,3 The aim of this Medication Use Evaluation (MUE) is to investigate the frequency of ASM switch from LEV to BRV due to BAEs, evaluate the recurrence of BAEs in veterans switched to BRV, and identify the dose at which BAEs occur in these veterans.
1. Steinhoff BJ and Staack AM. Levetiracetam and brivaracetam: a review of evidence from clinical trials and clinical experience. Therapeutic Advances in Neurological Disorders. 2019;12:1-23.
2. Yates SL, Fakhoury T, Liang W, et al. An open-label, prospective, exploratory study of patients with epilepsy switching from levetiracetam to brivaracetam. Epilepsy & Behavior. 2015;52:165-168.
3. Abraira L, Salas-Puig J, Quitana M, et al. Overnight switch from levetiracetam to brivaracetam. Safety and tolerability. Epilepsy & Behavior. 2021;16:100504.
Methods: We conducted an MUE including veterans aged 18 years or older on BRV, who were identified through a list of PBM consults places between June 1, 2016 and November 30, 2023. We also collected a total number of individual veterans on LEV between June 1, 2016 and November 30, 2023 identified through active prescriptions during that time period. Veterans were excluded if they had inadequate data in the patient chart, no history of LEV use or never started on BRV. Data collection included patient demographics, timing and duration of LEV and BRV therapy, efficacy of LEV and BRV therapy, doses and ADEs documented to LEV and BRV therapy, and method used to switch from LEV to BRV. Descriptive statistics were performed as appropriate.
Results: A total of 1563 unique veterans with prescriptions for LEV between June 1, 2016 and November 30, 2023 were identified. A total of 68 (4.35%) of these veterans were switched to BRV during that time period. These 68 veterans were predominantly male (86.8%) and were an average age in years of 54.5 at the time of switch from LEV to BRV. A majority of the veterans had a documented psychiatric history (64.7%). Of the 68 veterans switched from LEV to BRV, 61.8% of them were switched due to BAEs. Only 7 of those veterans had documented BAEs on BRV. None of the veterans without documented BAEs on LEV developed BAEs on BRV. BAEs that occurred on BRV developed at a LEV:BRV dose ratio of 10:1.
Conclusions: While, generally, in adult populations, the incidence of BAEs is estimated at 13.3% of patients on LEV, only 4.35% of veterans at our institution were switched from LEV to BRV. In veterans with BAEs on LEV, switching to BRV was associated with a reduction in BAEs.
Funding: No funding to report.
Anti-seizure Medications