[Treatment of epilepsy with perampanel: conversion from add-on therapy to monotherapy]
R Toledano1,2, A Gil-Nagel1
1Hospital Ruber Internacional, 28034 Madrid, España.
Insights
Perampanel (PER) monotherapy is effective and well-tolerated for focal and generalized tonic-clonic seizures. Low doses of PER demonstrated high retention and responder rates in real-world clinical practice.
Area of Science:
- Neurology
- Pharmacology
Background:
- Perampanel (PER) is an antiepileptic drug approved for add-on therapy in specific seizure types.
- Evidence for PER monotherapy after switching from adjunctive therapy is reviewed.
Purpose of the Study:
- To evaluate the efficacy and tolerability of Perampanel (PER) monotherapy in epilepsy patients.
Main Methods:
- Retrospective analysis of two multicentre studies involving PER monotherapy.
- Review of four additional studies on conversion to PER monotherapy.
Main Results:
- Low PER doses (6-8 mg/day) were effective and well-tolerated in a subgroup of patients.
- Retention rates exceeded 90% at 3 months and 70% at 12 months.
- Responder rates were over 75% at 3 months, with seizure-free rates over 50% at 6 months.
Conclusions:
- Conversion to PER monotherapy is an effective and well-tolerated treatment option.
- This approach is suitable for patients with focal and generalized tonic-clonic seizures in routine clinical practice.
Introduction:
Perampanel (PER) is an antiepileptic drug approved in Europe as add-on therapy for patients with focal onset seizures (with or without secondary generalisation) from the age of 4 years, and for primary generalised tonic-clonic seizures from 7 years of age.
Objective:
Review current evidence on treatment with PER monotherapy after conversion from adjunctive therapy.
Development:
Two retrospective multicentre studies in which PER was used as monotherapy show that low doses (6-8 mg/day) of PER were effective and well tolerated in a subgroup of patients with less severe epilepsies than patients who participated in clinical trials (where PER was used as add-on therapy). In these studies, the retention rate exceeded 90% at 3 months, and 70% at 6, and 12 months. The responder rate was > 75% at 3 months, and the rate of seizure-free patients exceeded 50% at 3 and 6 months, and 37% at 12 months. Compared to other observational studies and clinical trials where PER was used as add-on therapy, no adverse effects other than those already known were observed. Four other studies examining the effects of conversion to PER monotherapy in a small number of patients support these results.
Conclusions:
In routine clinical practice, conversion to PER monotherapy, at relatively low doses, is an effective and well-tolerated treatment for patients with focal and generalised tonic-clonic seizures.
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