Abstracts

Rationale: Brivaracetam (BRV), a selective, high-affinity ligand for synaptic vesicle protein 2A, is a new antiepileptic drug (AED) for adjunctive treatment of focal (partial-onset) seizures in adults (US market availability: May 12, 2016). A retrospective analysis was done using large US medical and prescription claims databases to describe patients who started BRV treatment. Methods: QuintilesIMS longitudinal prescription claims were linked to medical claims to identify patients ≥16 yrs old with epilepsy newly initiated on BRV. Inclusion criteria were AED treatment between Feb 1, 2016 and Sept 30, 2016 (index date = first AED prescription), and ≥1 claim in both the year before and 3 months after index. Exclusion criteria included >1 new AED on the index date (apart from BRV and levetiracetam [LEV]) and missing information. Analyses included patient characteristics, AED history, BRV adherence and persistence. Patients were considered persistent if they did not discontinue BRV in the 3-month follow-up period, and adherent if they were supplied with medication for ≥80% of days during the 3-month follow-up period. Results: 777 patients newly initiated on BRV were identified: 427 (55.0%) with no LEV use currently or in the past year (LEV-naïve cohort), 252 (32.4%) who had used and discontinued LEV in the past year (prior LEV cohort), 98 (12.6%) on concomitant LEV at BRV initiation (concomitant LEV cohort). Overall mean (SD) age was 40.4 (15.5) yrs; 42.5% were male. Demographic characteristics were similar across cohorts (Table 1). Patients taking concomitant LEV were more likely to be insured by Medicaid or Medicare than those in other cohorts. LEV-naïve patients had fewer AEDs in the past year than those in prior LEV or concomitant LEV cohorts. The most common BRV starting dose was 100 mg/day, followed by 200 and 50 mg/day (Table 2). Few patients started outside the recommended dose range ( < 50 or >200 mg/day). Evaluation of the last recorded BRV dose indicated that some dose escalation occurred. In the concomitant LEV cohort, 38 (38.8%) patients had LEV dose ≥3000 mg/day when starting BRV (Table 2), and 43.9% discontinued LEV within 3 months of starting BRV. Overall, 394 (50.7%) patients treated with BRV were persistent and 421 (54.2%) were adherent at 3 months follow-up (Table 1). Persistence and adherence were similar across cohorts. Conclusions: In this retrospective, claims-based analysis, the most common BRV starting dose was 100 mg/day. Almost half of patients (350, 45.0%) had used LEV in the past year, with ~one-third (252, 32.4%) discontinuing LEV before starting BRV. Persistence and adherence to BRV were similar regardless of prior LEV use. Almost half of patients on a combination of BRV and LEV discontinued LEV which indicates switching within 3 months of starting BRV. Overall, BRV use was consistent with FDA labeling and adherence was comparable with expected epilepsy adherence rates.1 Findings are limited by the claims data source and short follow-up. 1Faught E. Epilepsy Behav 2012;25:297–302 Funding: Study sponsored by UCB Pharma