Perampanel as therapy for adult epilepsy patients treated in clinical practice_Journal of Epilepsy

Authors：

ZHANG Kaiyue ^1,2 , ZHENG Zhaoshi ¹ , WANG Han ¹ ,  LIU Songyan ¹

1. Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun 130033, China;
2. Department of Neurology, Shengli Oilfield Central Hospital, Dongying 257000, China;

Corresponding author：

LIU Songyan, Email: liu_sy@jlu.edu.cn

Keywords：

Perampanel; Adult epilepsy; Efficacy; Safety

DOI：

10.7507/2096-0247.202306008

Video：

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Objective To evaluate the clinical efficacy and safety tolerance of perampanel in the treatment of Chinese adult epilepsy patients. Methods Clinical data of adult epileptic patients treated with perampanel in Department of Neurology, China-Japan Union Hospital of Jilin University from January 2020 to December 2022 were analyzed retrospectively by self-control method, including demographic and clinical characteristics of patients, changes of epileptic seizures before and after perampanel treatment and adverse events during the treatment of perampanel. To evaluate the clinical efficacy and safety of perampanel in Chinese adult epileptic patients. Results A total of 69 adult epileptic patients with complete follow-up data were included. The dosage range of perampanel was 2 ~ 8 mg. The total effective rate was 68.1%, and the seizure-free rate was 17.4%. The most common adverse reactions were mood change and dizziness, the incidence of adverse reactions was 52.2%, and the incidence of serious adverse reactions was 0.0%. In terms of analysis of influencing factors of efficacy, the results showed that single drug therapy or combination therapy, type of combined antiepileptic drug and treatment time of perampanel did not affect the efficacy (P>0.05), while dosage was an important factor affecting the efficacy of perampanel (P<0.05), and there was no significant difference in efficacy between the focal epilepsy group and the general epilepsy group (P>0.05). In terms of the analysis of factors related to the occurrence of adverse reactions, the results showed that the occurrence of adverse reactions was related to the dosage of perampanel (P<0.05), and was independent of whether it was monotherapy, the addition time of perampanel and the type of combined antiepileptic agents (P>0.05). Conclusion Perampanel has good efficacy and safety tolerance in the treatment of epilepsy in Chinese adults. Both monotherapy and additive therapy can effectively control seizures, and has a good effect on different seizure types. The most common adverse events during treatment were mood changes and dizziness, which could be alleviated and tolerated by most patients with prolonged treatment.

Citation： ZHANG Kaiyue, ZHENG Zhaoshi, WANG Han, LIU Songyan. Perampanel as therapy for adult epilepsy patients treated in clinical practice. Journal of Epilepsy, 2023, 9(5): 369-374. doi: 10.7507/2096-0247.202306008 Copy

1.	Hanada T. The discovery and development of perampanel for the treatment of epilepsy. Expert Opin Drug Discov, 2014, 9(4): 449-458.
2.	Barygin OI. Inhibition of calcium-permeable and calcium-impermeable AMPA receptors by perampanel in rat brain neurons. Neurosci Lett, 2016, 633: 146-151.
3.	史卫忠, 徐春敏, 韩容. 新型口服抗癫痫药吡仑帕奈. 药品评价, 2012, 9(29): 33-37.
4.	Yu T, Teng Z, Liu X, et al. Effectiveness of perampanel in the treatment of pediatric patients with focal epilepsy and ESES: a single-center retrospective study. Front Pharmacol, 2022, 13: 1026836.
5.	Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia, 2017, 58(4): 512-521.
6.	乐格, 莫亚雄. 生酮饮食治疗儿童难治性癫痫的研究进展. 现代临床医学, 2017, 43(4): 251-254.
7.	French JA, Krauss GL, Biton V, et al. Adjunctive perampanel for refractory partial-onset seizures: randomized phase III study 304. Neurology, 2012, 79(6): 589-596.
8.	French JA, Krauss GL, Steinhoff BJ, et al. Evaluation of adjunctive perampanel in patients with refractory partial-onset seizures: results of randomized global phase III study 305. Epilepsia, 2013, 54(1): 117-125.
9.	Krauss GL, Serratosa JM, Villanueva V, et al. Randomized phase III study 306: adjunctive perampanel for refractory partial-onset seizures. Neurology, 2012, 78(18): 1408-1415.
10.	Nishida T, Lee SK, Inoue Y, et al. Adjunctive perampanel in partial-onset seizures: Asia-Pacific, randomized phase III study. Acta Neurol Scand, 2018, 137(4): 392-399.
11.	French JA, Wechsler RT, Trinka E, et al. Long-term open-label perampanel: generalized tonic-clonic seizures in idiopathic generalized epilepsy. Epilepsia Open, 2022, 7(3): 393-405.
12.	Yamamoto T, Lim SC, Ninomiya H, et al. Efficacy and safety of perampanel monotherapy in patients with focal-onset seizures with newly diagnosed epilepsy or recurrence of epilepsy after a period of remission: The open-label Study 342 (FREEDOM Study). Epilepsia Open, 2020, 5(2): 274-284.
13.	Toledano Delgado R, García-Morales I, Parejo-Carbonell B, et al. Effectiveness and safety of perampanel monotherapy for focal and generalized tonic-clonic seizures: experience from a national multicenter registry. Epilepsia, 2020, 61(6): 1109-1119.
14.	Gidal BE, Laurenza A, Hussein Z, et al. Perampanel efficacy and tolerability with enzyme-inducing AEDs in patients with epilepsy. Neurology, 2015, 84(19): 1972-1980.
15.	Johannessen SI, Landmark CJ. Antiepileptic drug interactions - principles and clinical implications. Curr Neuropharmacol, 2010, 8(3): 254-267.
16.	Steinhoff BJ, Patten A, Williams B, et al. Efficacy and safety of adjunctive perampanel 4 mg/d for the treatment of focal seizures: a pooled post hoc analysis of four randomized, double-blind, phase III studies. Epilepsia, 2020, 61(2): 278-286.
17.	Takahashi S, Shimizu K, Inaji M, et al. Effectiveness of perampanel as a first add-on antiepileptic drug for the treatment of partial epilepsy. Epilepsy & Behavior, 2019, 100(Pt A): 106492.
18.	Rodríguez Osorio X, LemaFacal T, RubioNazábal E, et al. Perampanel effectiveness and safety as early add-on treatment for focal-onset seizures: PEREAGAL study. Epilepsy Res, 2021, 172: 106570.
19.	Ettinger AB, LoPresti A, Yang H, et al. Psychiatric and behavioral adverse events in randomized clinical studies of the noncompetitive AMPA receptor antagonist perampanel. Epilepsia, 2015, 56(8): 1252-1263.
20.	RuggGunn F. Adverse effects and safety profile of perampanel: a review of pooled data. Epilepsia, 2014, 55 Suppl 1: 13-15.
21.	Huang C, Boonyapisit K, Gunadharma S, et al. Optimal use of perampanel in elderly asian patients with epilepsy: expert opinion. Ther Clin Risk Manag, 2022, 18: 825-832.

1. Hanada T. The discovery and development of perampanel for the treatment of epilepsy. Expert Opin Drug Discov, 2014, 9(4): 449-458.
2. Barygin OI. Inhibition of calcium-permeable and calcium-impermeable AMPA receptors by perampanel in rat brain neurons. Neurosci Lett, 2016, 633: 146-151.
3. 史卫忠, 徐春敏, 韩容. 新型口服抗癫痫药吡仑帕奈. 药品评价, 2012, 9(29): 33-37.
4. Yu T, Teng Z, Liu X, et al. Effectiveness of perampanel in the treatment of pediatric patients with focal epilepsy and ESES: a single-center retrospective study. Front Pharmacol, 2022, 13: 1026836.
5. Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia, 2017, 58(4): 512-521.
6. 乐格, 莫亚雄. 生酮饮食治疗儿童难治性癫痫的研究进展. 现代临床医学, 2017, 43(4): 251-254.
7. French JA, Krauss GL, Biton V, et al. Adjunctive perampanel for refractory partial-onset seizures: randomized phase III study 304. Neurology, 2012, 79(6): 589-596.
8. French JA, Krauss GL, Steinhoff BJ, et al. Evaluation of adjunctive perampanel in patients with refractory partial-onset seizures: results of randomized global phase III study 305. Epilepsia, 2013, 54(1): 117-125.
9. Krauss GL, Serratosa JM, Villanueva V, et al. Randomized phase III study 306: adjunctive perampanel for refractory partial-onset seizures. Neurology, 2012, 78(18): 1408-1415.
10. Nishida T, Lee SK, Inoue Y, et al. Adjunctive perampanel in partial-onset seizures: Asia-Pacific, randomized phase III study. Acta Neurol Scand, 2018, 137(4): 392-399.
11. French JA, Wechsler RT, Trinka E, et al. Long-term open-label perampanel: generalized tonic-clonic seizures in idiopathic generalized epilepsy. Epilepsia Open, 2022, 7(3): 393-405.
12. Yamamoto T, Lim SC, Ninomiya H, et al. Efficacy and safety of perampanel monotherapy in patients with focal-onset seizures with newly diagnosed epilepsy or recurrence of epilepsy after a period of remission: The open-label Study 342 (FREEDOM Study). Epilepsia Open, 2020, 5(2): 274-284.
13. Toledano Delgado R, García-Morales I, Parejo-Carbonell B, et al. Effectiveness and safety of perampanel monotherapy for focal and generalized tonic-clonic seizures: experience from a national multicenter registry. Epilepsia, 2020, 61(6): 1109-1119.
14. Gidal BE, Laurenza A, Hussein Z, et al. Perampanel efficacy and tolerability with enzyme-inducing AEDs in patients with epilepsy. Neurology, 2015, 84(19): 1972-1980.
15. Johannessen SI, Landmark CJ. Antiepileptic drug interactions - principles and clinical implications. Curr Neuropharmacol, 2010, 8(3): 254-267.
16. Steinhoff BJ, Patten A, Williams B, et al. Efficacy and safety of adjunctive perampanel 4 mg/d for the treatment of focal seizures: a pooled post hoc analysis of four randomized, double-blind, phase III studies. Epilepsia, 2020, 61(2): 278-286.
17. Takahashi S, Shimizu K, Inaji M, et al. Effectiveness of perampanel as a first add-on antiepileptic drug for the treatment of partial epilepsy. Epilepsy & Behavior, 2019, 100(Pt A): 106492.
18. Rodríguez Osorio X, LemaFacal T, RubioNazábal E, et al. Perampanel effectiveness and safety as early add-on treatment for focal-onset seizures: PEREAGAL study. Epilepsy Res, 2021, 172: 106570.
19. Ettinger AB, LoPresti A, Yang H, et al. Psychiatric and behavioral adverse events in randomized clinical studies of the noncompetitive AMPA receptor antagonist perampanel. Epilepsia, 2015, 56(8): 1252-1263.
20. RuggGunn F. Adverse effects and safety profile of perampanel: a review of pooled data. Epilepsia, 2014, 55 Suppl 1: 13-15.
21. Huang C, Boonyapisit K, Gunadharma S, et al. Optimal use of perampanel in elderly asian patients with epilepsy: expert opinion. Ther Clin Risk Manag, 2022, 18: 825-832.

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