In an exploratory trial, efficacy and safety of brivaracetam and lorazepam for controlling acute seizures were compared. The similar efficacy suggests a possible role of brivaracetam in this setting .
The study was designed as a phase 2, open-label, randomised, parallel-group, active-controlled proof-of-concept trial. Participants were adult patients admitted to an Epilepsy Monitoring Unit (EMU) in Birmingham, USA. They were randomised 1:1:1 to single-dose bolus intravenous lorazepam, brivaracetam 100 mg (BRV100), or brivaracetam 200 mg (BRV200), which was administered when a seizure required intervention. The primary efficacy outcome was time to next seizure or use of rescue medication.
Of 45 randomised patients who received trial medication for a qualifying seizure, 11 (24.4%) had a seizure within 12 hours (lorazepam n=5, BRV100 n=3, BRV200n =3), suggesting similar efficacy across treatments. Most patients were seizure-free at 12 hours (lorazepam 60.0%, BRV100 80.0%, BRV200 80.0%). Rescue medication use at 12 hours was numerically higher for lorazepam (40.0%) than for brivaracetam (6.7% and 13.3%, respectively). Safety results were as expected. One lorazepam patient reported a seizure cluster.
1. Szaflarski J, et al. AAN 2019, S36.008.
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