Brivaracetam: new compound approved for the treatment of epilepsy

Brivaracetam was approved in the E.U. and U.S. at the beginning of 2016 for the adjunctive treatment of focal epilepsies in patients over 16 years of age. This compound is a novel high-affinity synaptic vesicle glycoprotein 2A (SV2A) ligand, with a selectivity for this protein that is 10- to 30-fold higher than that shown by levetiracetam. Preclinical studies show that brivaracetam might have a stronger anticonvulsant effect and distributes in the brain more quickly, when compared to levetiracetam. The agent has linear and simple pharmacokinetics and a low interaction potential. Six double-blind placebo-controlled studies have assessed doses from 5 to 200 mg/day. Significant efficacy has been observed from doses of 50 mg/day, but there was not a clear dose-effect relationship. Short-term tolerability was excellent with all doses. Adverse events significantly associated with brivaracetam were dizziness, somnolence, fatigue and irritability. An excellent tolerability profile has been found after administration of a formulation for intravenous use.