title: Brivaracetam add-on for refractory focal epilepsy: A systematic review and meta-analysis.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of the new antiepileptic drug brivaracetam (BRV) as add-on treatment for drug-resistant partial epilepsy using meta-analytical techniques.
  
  
  METHODS
  Randomized, placebo-controlled, single- or double-blind, add-on trials of BRV in adult patients with drug-resistant partial epilepsy were identified through a systematic literature search. The following outcomes were assessed: 50% or greater reduction in seizure frequency, seizure freedom, incidence of treatment-emergent adverse events (TEAEs), and treatment withdrawal. Risk ratio (RR) with 95% confidence interval was estimated for each outcome.
  
  
  RESULTS
  Six trials were included involving 2,399 participants according to the intent-to-treat, 1,715 for BRV, and 684 for placebo groups, respectively. The pooled RRs for the 50% responders and seizure freedom were 1.79 (1.51-2.12) and 4.74 (2.00-11.25), respectively. The subanalysis by levetiracetam (LEV) status did not show a statistically significant difference in the 50% responder rate when comparing BRV with placebo in patients with concomitant assumption of LEV. The TEAEs significantly associated with BRV were irritability (2.99 [1.28-6.97]), fatigue (2.19 [1.44-3.33]), somnolence (1.97 [1.45-2.68]), and dizziness (1.66 [1.19-2.31]). The overall RRs for treatment withdrawal due to TEAEs or any reason were 1.58 (1.04-2.40) and 1.27 (0.93-1.73), respectively.
  
  
  CONCLUSIONS
  In adults with drug-refractory focal epilepsy, add-on BRV was effective to reduce seizure frequency and fairly well-tolerated. Further studies are needed to draw definitive conclusions about its efficacy in non-LEV-naive participants and evaluate its long-term safety profile.
authors.affiliation: From the Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy. alfierelattanzisimona@gmail.com.
authors.forename: Simona
authors.initials: S
authors.lastname: Lattanzi
authors.affiliation: From the Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Cagnetti
authors.affiliation: From the Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Foschi
authors.affiliation: From the Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.
authors.forename: Leandro
authors.initials: L
authors.lastname: Provinciali
authors.affiliation: From the Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Silvestrini
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000494:pharmacology*; D000069279:Drug Resistant Epilepsy / Q000188:drug therapy*; D004828:Epilepsies, Partial / Q000188:drug therapy*; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011760:Pyrrolidinones / Q000008:administration & dosage / Q000494:pharmacology*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*
chemical_list: D000927:Anticonvulsants; D011760:Pyrrolidinones; C482793:brivaracetam