Comparison of the effectiveness and tolerability of perampanel and brivaracetam: a real-world, observational, retrospective study.

Perampanel (PER) and brivaracetam (BRV) are third-generation antiseizure medications. The aim of the present retrospective, double-centre study was to compare the effectiveness and tolerability between PER and BRV in adult patients with epilepsy. We reviewed the clinical charts of patients affected by epilepsy, admitted to the Epilepsy Centre at the University Hospital of Rome "Tor Vergata" and the Cardarelli Hospital in Naples, who started BRV or PER as add-on treatment for controlling seizures with a follow-up of 12 months. Seizure freedom, >50% seizure reduction, retention rate, and adverse events reported during follow-up were compared between the two drugs. Moreover, we considered the effects of both drugs in specific subsets of patients: age ≥60 years, male or female, in patients with genetic generalized epilepsy, and considering previous treatment with levetiracetam (LEV). Forty-three patients treated with BRV and 64 patients treated with PER were included in this study and followed at both sites for 12 months. Similar effectiveness was observed between BRV and PER, with similar rates of seizure freedom (30% vs 31%) and >50% seizure reduction (32% vs 34%) during follow-up. Moreover, PER and BRV discontinuation rates, due to ineffectiveness or adverse events, were similar. Groups of patients who started BRV or PER as first add-on treatments were also compared but no differences in effectiveness or tolerability were identified. Lastly, BRV was shown to be more effective in patients who were not previously treated with LEV. This retrospective study reveals comparable effectiveness and tolerability between PER and BRV also when used as first add-on treatments, in patients with epilepsy.