Preliminary Asian experience of using perampanel in clinical practice

Chiang, Hsing I.; Lim, Siew‐Na; Hsieh, Hsiang Yao; Cheng, Mu-Hua; Chang, Chun Wei; Tseng, Wei En Johnny; Li, Han Tao; Lin, Cheng Hui; Wu, Tony

doi:10.1016/j.bj.2017.09.003

Cited by 10 publications

(13 citation statements)

References 30 publications

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“…Irritability occurred in 3.1% (weighted mean) of patients treated with TPM (range, 2.7-20%), 5.6% with BRV (range, 4.0-6.6%), 9.9% with LEV (range, 1.8-26.7%), and 12.3% with PER (range, 1.4-33.7%) [9,28,29,[31][32][33][34][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54]. These results were reported in a total of 26 publications, which included 3 studies with BRV (n = 938), 9 studies and 1 regional subanalysis with LEV (n = 4995), 13 with PER (n = 1795), and 3 with TPM (n = 766).…”

Section: Incidences Of Irritability Anger and Aggressionmentioning

confidence: 99%

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Behavioral adverse events with brivaracetam, levetiracetam, perampanel, and topiramate: A systematic review

Steinhoff

Klein

Klitgaard

et al. 2021

Epilepsy & Behavior

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To understand the currently available post-marketing real-world evidence of the incidences of and discontinuations due to the BAEs of irritability, anger, and aggression in people with epilepsy (PWE) treated with the anti-seizure medications (ASMs) brivaracetam (BRV), levetiracetam (LEV), perampanel (PER), and topiramate (TPM), as well as behavioral adverse events (BAEs) in PWE switching from LEV to BRV. Methods: A systematic review of published literature using the Cochrane Library, PubMed/MEDLINE, and Embase was performed to identify retrospective and prospective observational studies reporting the incidence of irritability, anger, or aggression with BRV, LEV, PER, or TPM in PWE. The incidences of these BAEs and the rates of discontinuation due to each were categorized by ASM, and where possible, weighted means were calculated but not statistically assessed. Behavioral and psychiatric adverse events in PWE switching from LEV to BRV were summarized descriptively. Results: A total of 1500 records were identified in the searches. Of these, 44 published articles reporting 42 studies met the study criteria and were included in the data synthesis, 7 studies were identified in the clinical trial database, and 5 studies included PWE switching from LEV to BRV. Studies included a variety of methods, study populations, and definitions of BAEs. While a wide range of results was reported across studies, weighted mean incidences were 5.6% for BRV, 9.9% for LEV, 12.3% for PER, and 3.1% for TPM for irritability; 3.3%* for BRV, 2.5% for LEV, 2.0% for PER, and 0.2%* for TPM for anger; and 2.5% for BRV, 2.6% for LEV, 4.4% for PER, and 0.5%* for TPM for aggression. Weighted mean discontinuation rates were 0.8%* for BRV, 3.4% for LEV, 3.0% for PER, and 2.2% for TPM for irritability and 0.8%* for BRV, 2.4% for LEV, 9.2% for PER, and 1.2%* for TPM for aggression. There were no discontinuations for anger. Switching from LEV to BRV led to improvement in BAEs in 33.3% to 83.0% of patients (weighted mean, 66.6%).*Denotes only 1 study.

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Section: Incidences Of Irritability Anger and Aggressionmentioning

confidence: 99%

“…Aggression was reported for 4.4% (weighted mean; range, 1.0-24.5 %) of patients treated with PER, 2.6% (range, 1.4-20.0%) treated with LEV, and 2.5% (range, 1.0-12.0%) treated with BRV [9,30,32,33,36,37,40,41,44,47,48,[50][51][52][61][62][63][64][65][66][67].…”

Section: Incidences Of Irritability Anger and Aggressionmentioning

confidence: 99%

Behavioral adverse events with brivaracetam, levetiracetam, perampanel, and topiramate: A systematic review

Steinhoff

Klein

Klitgaard

et al. 2021

Epilepsy & Behavior

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“…In this retrospective analysis of 210 patients with epilepsy, Chiang et al. [20] find that with around 50% of patients responding to treatment, the efficacy of perampanel is similar to that observed in other ethnic groups. Their findings however warn that patients with pre-existing psychiatric conditions and taking perampanel require special monitoring.…”

Section: Also In This Issuementioning

confidence: 57%

Microbes are off the menu: Defective macrophage phagocytosis in COPD

Walton¹

2017

Biomedical Journal

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In this issue of the Biomedical Journal, we learn about the pathophysiology of chronic obstructive pulmonary disease and how defective macrophage phagocytosis may lead to the build up of microbes and pollutants in inflamed lungs. We also focus on new findings that may take us a step closer to full automation in diagnostic bacteriology laboratories. Finally, we highlight the anti-tumor properties of microalgae and the application of algorithms to predict human emotion from electrocardiogram.

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“…I cannot rule out pharmacodynamic interaction(s) between PER and phenytoin, however no food aversion was previously reported 10,23,24. It is highly unlikely that aversion was caused by PER-induced pharmacokinetic changes of phenytoin or CLZ as PER at this dose is neither a potent inhibitor nor inducer of liver enzymes 1.…”

Section: Discussionmentioning

confidence: 86%

Perampanel-induced, new-onset food aversion in a 29-year-old female with medically refractory frontal lobe epilepsy

Marvanová¹

2019

Mental Health Clinician

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Background Perampanel is a selective, noncompetitive amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid glutamate receptor antagonist indicated for management of partial-onset and primary generalized seizures in epilepsy patients aged ≥12 years. Patient History A 29-year-old, white female with significant history of medically refractory frontal lobe epilepsy, status post right frontal and temporal resections, was initiated on perampanel as an add-on therapy to phenytoin extended-release (330 mg/d) and clonazepam (2.5 mg/d). She previously failed several antiepileptic drugs because of inefficacy and/or intolerance. Perampanel was initiated at 2 mg/d and the dose was increased by 2 mg/d increments every 2 to 3 weeks. Following the first dose, nausea and drowsiness were reported but resolved the following day. Three days after titration to 6 mg/d, the patient developed complete food aversion and became more irritable and anxious while no seizure frequency improvement was noted. No change of sense of taste was reported. After reduction to 4 mg/d, adverse effects improved but did not completely resolve until 2 months following perampanel discontinuation. Review of Literature A PubMed search revealed no published literature or case reports of perampanel-induced food aversion or anorexia in a presence or absence of phenytoin and clonazepam. Conclusion In this report, a temporal relationship was observed between perampanel dose-increase and the development of food aversion. Return to baseline appetite and eating habits following perampanel discontinuation strongly suggest perampanel involvement. At this time, the exact mechanism(s) behind food aversion associated with perampanel is/are unknown.

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Preliminary Asian experience of using perampanel in clinical practice

Cited by 10 publications

References 30 publications

Behavioral adverse events with brivaracetam, levetiracetam, perampanel, and topiramate: A systematic review

Behavioral adverse events with brivaracetam, levetiracetam, perampanel, and topiramate: A systematic review

Microbes are off the menu: Defective macrophage phagocytosis in COPD

Perampanel-induced, new-onset food aversion in a 29-year-old female with medically refractory frontal lobe epilepsy

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