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Brivaracetam

(Briviact®)

Briviact®

Drug updated on 12/11/2024

Dosage FormTablet (oral; 10 mg, 25 mg, 50 mg, 75 mg, 100 mg); solution (oral; 10 mg/mL); injection (intravenous; 50 mg/ 5 mL)
Drug ClassAntiepileptics
Ongoing and
Completed Studies		ClinicalTrials.gov

Indication

  • Indicated for the treatment of partial-onset seizures in patients 1 month of age and older.

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Summary
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  • This summary is based on the review of 17 systematic review(s)/meta-analysis(es). [1-17]
  • Seizure Reduction: Brivaracetam achieved a 50% or greater reduction in seizure frequency with a relative risk (RR) of 1.81 (95% confidence interval (CI) 1.53–2.14) across six studies. For focal and focal to bilateral tonic-clonic seizures (FBTCS), sustained seizure reductions of ≥75%, ≥90%, and 100% were higher from day one with brivaracetam (BRV) dosages of 100 and 200 mg/day compared to placebo (P < .01).
  • Seizure Freedom: BRV was associated with a higher likelihood of seizure freedom, with a relative risk of 5.89 (95% CI 2.30–15.13) in six studies. In pediatric populations, 18% achieved complete seizure freedom (95% CI 0.10–0.25).
  • Effectiveness in Children and Drug-Resistant Epilepsy: Among children (≤18 years) with epilepsy, BRV showed a responder rate of 35% (95% CI 0.24–0.47). In adults with drug-resistant epilepsy, BRV was effective as an add-on therapy, significantly reducing seizure frequency and enhancing seizure freedom rates.
  • Comparative Effectiveness with Other Antiepileptic Drugs: Network meta-analysis indicated that BRV and lacosamide (LCM) were among the best-tolerated treatments, while cenobamate (CNB) ranked higher in efficacy for achieving a ≥50% reduction in seizure frequency.
  • Overall Incidence of Adverse Events (AEs): Treatment-emergent adverse events (TEAEs) were reported in 66.9% of patients receiving BRV versus 62.8% in the placebo group. Common TEAEs included somnolence (13.3% vs. 7.9% for placebo), dizziness (10.0% vs. 7.0%), headache (10.5% vs. 11.5%), and fatigue (8.2% vs. 4.2%).
  • Psychiatric and Behavioral Disorders: Psychiatric-related TEAEs were observed in 11.3% of BRV-treated patients compared to 8.2% in the placebo group. Behavioral issues, such as irritability, were noted in 2.7% of BRV-treated patients versus 1.5% for placebo.
  • Withdrawals Due to Adverse Events: Patients on BRV showed a higher rate of withdrawal due to adverse events, with a relative risk of 1.54 (95% CI 1.02–2.33) compared to placebo, across six studies.

Product Monograph / Prescribing Information

Document TitleYearSource
Briviact (brivaracetam) Prescribing Information.2023UCB, Inc., Smyrna, GA

Systematic Reviews / Meta-Analyses

Document TitleYearSource
Third generation antiseizure medications exposure during pregnancy and neonatal adverse birth outcomes: A systematic review2024Science Progress
A comparison of cenobamate with other newer antiseizure medications for adjunctive treatment of focal-onset seizures: A systematic review and network meta-analysis2024Seizure
The efficacy and safety of third-generation antiseizure medications and non-invasive brain stimulation to treat refractory epilepsy: a systematic review and network meta-analysis study2023Frontiers in Neurology
Safety and efficacy of brivaracetam in children epilepsy: a systematic review and meta-analysis2023Frontiers in Neurology
Cost-effectiveness of cenobamate for focal seizures in people with drug-resistant epilepsy2023Epilepsia
Brivaracetam add-on therapy for drug-resistant epilepsy2022The Cochrane Database of Systematic Reviews
Third-Generation Antiseizure Medications for Adjunctive Treatment of Focal-Onset Seizures in Adults: A Systematic Review and Network Meta-analysis2022Drugs
Indirect treatment comparison of cenobamate to other ASMs for the treatment of uncontrolled focal seizures2022Epilepsy & Behavior
Suicidality Risk of Newer Antiseizure Medications: A Meta-analysis2021JAMA Neurology
Brivaracetam: How Well Does It Fare as an Anti-Epileptic? A Review2021Neurology India
Anti-seizure medications and efficacy against focal to bilateral tonic-clonic seizures: A systematic review with relevance for SUDEP prevention2021Epilepsy & Behavior
Brivaracetam for the treatment of focal-onset seizures: pharmacokinetic and pharmacodynamic evaluations2020Expert Opinion on Drug Metabolism & Toxicology
A systematic review and indirect treatment comparison of perampanel versus brivaracetam as adjunctive therapy in patients with focal-onset seizures with or without secondary generalization2020Epilepsy Research
Time course of drug-related treatment-emergent adverse side effects of brivaracetam2020Epilepsy & Behavior
Time course of 75%-100% efficacy response of adjunctive brivaracetam2020Acta Neurologica Scandinavica
Efficacy and tolerability of intravenous brivaracetam for status epilepticus: A systematic review2020Journal of the Neurological Sciences
Safety and tolerability of adjunctive brivaracetam in epilepsy: In-depth pooled analysis2020Epilepsy & Behavior

Clinical Practice Guidelines

Document TitleYearSource
Brivaracetam use in clinical practice: a Delphi consensus on its role as first add-on therapy in focal epilepsy and beyond2024Neurological Sciences
Clinical guidelines for the management of epilepsy.2020The Epilepsy Research Program of the Ontario Brain institute