Article
作者: Brower, Richard ; Webb, Randall ; Sosa, Veronica ; Floridia, Jorge ; Puri, Vinay ; Kumar, Dinesh ; Miller, John ; Herrman, Craig ; Silva, Walter ; Krauss, Gregory L. ; Laurenza, Antonio ; Aung-Din, Ronald ; Biton, Victor ; Firstenfeld, Alfredo ; Miranda, Fernando ; Elterman, Roy ; Wheless, James ; Chung, Steve ; Nofal, Pedro ; Rodríguez, Ildefonso ; Pillay, Neelan ; Bautista, Ramon ; Mesri, Jacobo ; Klapper, Jack ; Leroy, Robert ; Morales, Sarug Reyes ; Hogan, Robert ; Milian, Albino Contreras ; Pociecha, Juan ; Clement, Jean-Francois ; Klein, Pavel ; Kankirawatana, Pongkiat ; Nieto, Flavia ; Thomson, Alfredo ; Halford, Jonathan ; Zuin, Daniel ; Renfroe, Ben ; Steiner, David ; Modur, Pradeep ; Sperling, Michael ; McLachlan, Richard ; Knowlton, Robert ; Yerby, Mark ; Szaflarski, Jerzy ; Tenhamm, Eugenio ; Peralta, Balduin Lawson ; Moore, David ; Teasley, Jean ; Goodpasture, Hewitt ; Flamini, J. ; Cristalli, Diana ; Brown, Lawrence ; Charlet, Michael ; Sfaello, Ignacio ; Hwang, Paul ; King-Stephens, David ; Davis, Ronald ; Kalra, Arun ; Squillacote, David ; Fessler, Albert ; Mitchell, Wendy ; Ayala, Ricardo ; Owen, Meriem Bensalem ; Enlow, Thomas ; Conry, Joan ; Campanille, Verónica ; Yang, Haichen ; Wilfong, Angus ; Barroso, Noe ; Armstrong, Robert ; Shneker, Bassel ; Gruenthal, Michael ; Ilari, Rita ; Jain, Sanjay ; Krauss, Gregory ; Lasso, Jorge ; Ferreira, Jose ; Hernandez, Marcelo Leiva ; French, Jacqueline A. ; Lesch, David ; Rogawski, Michael A. ; Ali, Imran ; Consalvo, Damián E.
OBJECTIVE:To assess efficacy and safety of once-daily 8 or 12 mg perampanel, a noncompetitive α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA) receptor antagonist, when added to concomitant antiepileptic drugs (AEDs) in the treatment of drug-resistant partial-onset seizures.
METHODS:This was a multicenter, double-blind, placebo-controlled trial (ClinicalTrials.gov identifier: NCT00699972). Patients (≥12 years, with ongoing seizures despite 1-3 AEDs) were randomized (1:1:1) to once-daily perampanel 8 mg, 12 mg, or placebo. Following baseline (6 weeks), patients entered a 19-week double-blind phase: 6-week titration (2 mg/week increments to target dose) followed by a 13-week maintenance period. Percent change in seizure frequency was the primary endpoint; 50% responder rate was the primary endpoint for EU registration.
RESULTS:Of 388 patients randomized and treated, 387 provided seizure frequency data. Using this intent-to-treat population over the double-blind phase, the median percent change in seizure frequency was -21.0%, -26.3%, and -34.5% for placebo and perampanel 8 and 12 mg, respectively (p = 0.0261 and p = 0.0158 for 8 and 12 mg vs placebo, respectively). Fifty percent responder rates during the maintenance period were 26.4%, 37.6%, and 36.1%, respectively, for placebo, perampanel 8 mg, and perampanel 12 mg; these differences were not statistically significant for 8 mg (p = 0.0760) or 12 mg (p = 0.0914). Sixty-eight (17.5%) patients discontinued, including 40 (10.3%) for adverse events. Most frequent treatment-emergent adverse events were dizziness, somnolence, irritability, headache, fall, and ataxia.
CONCLUSIONS:This trial demonstrated that once-daily, adjunctive perampanel at doses of 8 or 12 mg improved seizure control in patients with uncontrolled partial-onset seizures. Doses of perampanel 8 and 12 mg were safe, and tolerability was acceptable.
CLASSIFICATION OF EVIDENCE:This study provides Class I evidence that once-daily 8 and 12 mg doses of adjunctive perampanel are effective in patients with uncontrolled partial-onset seizures.