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.