Clinical factors associated with perampanel retention, response, seizure freedom and tolerability: real-world...

Perampanel (PER) is effective in treating focal and generalised seizures. The PERaMpanel pooled analysIs of effecTiveness and tolerability (PERMIT) Extension study was a large, pooled analysis of PER clinical practice studies that assessed the effectiveness and safety/tolerability of PER in over 6800 people with epilepsy.

To determine clinical factors associated with PER retention, response, seizure freedom and tolerability when used in clinical practice.

An exploratory post hoc analysis of data from all individuals included in PERMIT Extension.

Univariate and multivariable logistic regression analyses were performed to identify baseline factors associated with retention rate, responder rate (⩾50% seizure frequency reduction), seizure freedom rate (no seizures since at least the previous visit) and incidence of adverse events (AEs).

A total of 6822 people with epilepsy treated with PER were included. Baseline factors associated with retention were absence of psychiatric comorbidity (odds ratio [95% confidence interval], 1.99 [1.403-2.825]; p < 0.001), fewer focal seizures (1.01 [1.004-1.014]; p < 0.001) and fewer previous antiseizure medications (ASMs; 1.06 [1.013-1.119]; p = 0.013). Factors associated with response were absence of focal seizures (2.12 [1.532-2.924]; p < 0.001), fewer previous ASMs (1.19 [1.136-1.250]; p < 0.001) and absence of concomitant sodium channel blocker (SCB) ASM(s) (1.96 [1.455-2.628]; p < 0.001). Factors associated with seizure freedom were fewer total seizures (1.04 [1.020-1.061]; p < 0.001), absence of focal seizures (3.45 [2.387-4.979]; p < 0.001), fewer previous ASMs (1.11 [1.028-1.205]; p = 0.008), absence of concomitant SCB ASM(s) (1.46 [1.051-2.028]; p = 0.024) and absence of concomitant gamma-aminobutyric acid (GABA)-ergic ASM(s) (2.08 [1.266-3.412]; p = 0.004). Factors associated with occurrence of AEs were older age (1.01 [1.006-1.015]; p < 0.001), longer epilepsy duration (1.01 [1.010-1.012]; p = 0.044), presence of psychiatric comorbidity (1.74 [1.469-2.062]; p < 0.001) and greater number of previous ASMs (1.09 [1.069-1.119]; p < 0.001).

This study identified clinical factors associated with PER's real-world effectiveness and tolerability, which may help inform treatment decisions in clinical practice.