UCB presents latest research and clinical advancement across leading epilepsy portfolio at International Epilepsy Congress
UCB (OTC:UCBJY) will present 26 scientific abstracts at the International Epilepsy Congress (IEC) in Lisbon, focusing on developmental and epileptic encephalopathies (DEEs) and prolonged seizures. Key highlights include a combined open-label extension study of FINTEPLA® (fenfluramine) involving 412 patients with Dravet syndrome or Lennox-Gastaut syndrome, showing sustained benefits and no new safety concerns.
The presentations encompass research on diagnostic challenges in adult DEE patients, caregiver experiences, and the impact of prolonged seizures. Notable findings include a post-hoc analysis supporting the 2-minute cutoff for defining prolonged tonic-clonic seizures, and studies on seizure emergency care pathways. The company will also host a symposium on September 1st focusing on DEEs in adulthood.
UCB (OTC:UCBJY) presenterà 26 abstract scientifici al Congresso Internazionale sull’Epilessia (IEC) a Lisbona, con un focus sulle encefalopatie epilettiche dello sviluppo (DEE) e sulle crisi prolungate. Tra i punti salienti c’è uno studio in estensione open-label combinato su FINTEPLA® (fenfluramina), che ha coinvolto 412 pazienti con sindrome di Dravet o sindrome di Lennox-Gastaut, mostrando benefici duraturi senza nuove preoccupazioni di sicurezza.
Le presentazioni copriranno temi come le sfide diagnostiche negli adulti con DEE, le esperienze dei caregiver e l’impatto delle crisi prolungate. Risultati rilevanti includono un’analisi post-hoc che supporta il limite di 2 minuti per definire le crisi tonico-cloniche prolungate e studi sui percorsi di cura per le emergenze da crisi. L’azienda terrà inoltre un simposio il 1° settembre dedicato alle DEE in età adulta.
UCB (OTC:UCBJY) presentará 26 resúmenes científicos en el Congreso Internacional de Epilepsia (IEC) en Lisboa, centrados en encefalopatías epilépticas del desarrollo (DEE) y convulsiones prolongadas. Entre los puntos destacados figura un estudio de extensión de etiqueta abierta combinado sobre FINTEPLA® (fenfluramina), que incluyó a 412 pacientes con síndrome de Dravet o síndrome de Lennox-Gastaut, mostrando beneficios sostenidos sin nuevas señales de seguridad.
Las presentaciones abarcan investigaciones sobre los retos diagnósticos en pacientes adultos con DEE, las experiencias de los cuidadores y el impacto de las convulsiones prolongadas. Hallazgos notables incluyen un análisis post-hoc que respalda el umbral de 2 minutos para definir las convulsiones tónico-clónicas prolongadas, además de estudios sobre rutas de atención en emergencias por convulsiones. La compañía también organizará un simposio el 1 de septiembre centrado en las DEE en la edad adulta.
UCB (OTC:UCBJY)는 리스본에서 열리는 국제 간질학회(IEC)에서 발달성 및 간질성 뇌병증(DEE)과 장기발작을 중심으로 26편의 과학 초록을 발표합니다. 주요 내용으로는 FINTEPLA®(펜플라유라민)의 공개확장 연구를 통합한 분석이 있으며, 드라벳 증후군 또는 레녹스-가스토 증후군 환자 412명을 포함해 지속적인 효능을 보였고 새로운 안전성 문제는 관찰되지 않았습니다.
발표 주제에는 성인 DEE 환자의 진단적 어려움, 보호자 경험, 장기발작의 영향 등이 포함됩니다. 주목할 만한 결과로는 지속성 강직-간대성 발작을 정의하는 2분 기준을 지지하는 사후 분석과 발작 응급의료 경로에 대한 연구가 있습니다. 회사는 또한 9월 1일에 성인기 DEE를 주제로 심포지엄을 개최합니다.
UCB (OTC:UCBJY) présentera 26 résumés scientifiques au Congrès International de l’Épilepsie (IEC) à Lisbonne, axés sur les encéphalopathies épileptiques du développement (DEE) et les crises prolongées. Parmi les points forts figure une étude d'extension en ouvert combinée sur FINTEPLA® (fenfluramine) comprenant 412 patients atteints du syndrome de Dravet ou du syndrome de Lennox‑Gastaut, montrant des bénéfices durables sans nouveaux signaux de sécurité.
Les présentations couvrent des travaux sur les défis diagnostiques chez les adultes atteints de DEE, les expériences des aidants et l'impact des crises prolongées. Les résultats notables incluent une analyse post‑hoc soutenant la coupure à 2 minutes pour définir les crises tonico‑cloniques prolongées, ainsi que des études sur les parcours de prise en charge des urgences liées aux crises. La société organisera également un symposium le 1er septembre consacré aux DEE à l’âge adulte.
UCB (OTC:UCBJY) wird auf dem Internationalen Epilepsiekongress (IEC) in Lissabon 26 wissenschaftliche Abstracts präsentieren, die sich auf entwicklungsbedingte epileptische Enzephalopathien (DEE) und verlängerte Anfälle konzentrieren. Zu den Highlights zählt eine kombinierte Open‑Label‑Verlängerungsstudie zu FINTEPLA® (Fenfluramin) mit 412 Patienten mit Dravet‑Syndrom oder Lennox‑Gastaut‑Syndrom, die anhaltende Vorteile ohne neue Sicherheitsbedenken zeigte.
Die Vorträge behandeln Forschungen zu diagnostischen Herausforderungen bei erwachsenen DEE‑Patienten, Erfahrungen von Betreuern und die Auswirkungen verlängerten Anfallsverlaufs. Bedeutende Ergebnisse sind eine Post‑hoc‑Analyse, die die 2‑Minuten‑Grenze zur Definition verlängerter tonisch‑klonischer Anfälle stützt, sowie Studien zu Notfallbehandlungswegen bei Anfällen. Das Unternehmen veranstaltet zudem am 1. September ein Symposium zu DEE im Erwachsenenalter.
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- 26 scientific abstracts, including two oral presentations, demonstrate UCB's ongoing commitment to advancing research for people living with epilepsies
- Data include an open-label extension study describing the long-term safety of FINTEPLA®▼ (fenfluramine)[1] and global functioning in children and adults with Dravet syndrome or Lennox-Gastaut syndrome[2]
- Data provide insights on developmental and epileptic encephalopathies (DEEs), including a qualitative study addressing diagnostic challenges and benefits in adult care settings, and a caregiver survey exploring the daily impacts of unpredictable seizures and disruptive behaviors[3],[4]
- Additional focus on defining prolonged seizures and their real-world impact on patients and caregivers[5],[6],[7]
Dimitrios Bourikas, Global Medical Head of DEE and Epilepsy, UCB, commented: "At UCB, we are committed to driving improvements in all aspects of care for people living with epilepsies and severe epileptic conditions. The breadth of data we are presenting at the International Epilepsy Congress reflects our dedication to advancing innovative solutions that address real-world patient needs. By deepening insights into disease mechanisms, treatment outcomes, and the experiences of both patients and caregivers, we strive to shape a better future for those affected by epileptic conditions."
Highlights of data to be presented at IEC:
Fenfluramine:
A combined open-label extension (OLE) study enrolled 412 patients with DS or LGS who had participated in three previous fenfluramine studies, reporting no new or unexpected safety signals and long-term sustained benefit.[2]
Barriers and benefits of identifying patients with DEEs in adult care settings:
Although the diagnosis of DEEs in children has become routine, significant diagnostic gaps remain for adults. This qualitative study, based on interviews with caregivers and healthcare professionals in the
Unpredictable seizures and disruptive behavior in DEEs: Interim results of a caregiver survey:
An internet-based anonymous 63-question survey was distributed to caregivers of patients with DEEs by multiple DEE-specific patient groups. Nearly half of caregivers reported that high rates of disruptive seizures/behavior led to temporary loss in abilities, previously associated with reduced quality of life.[3]
Prolonged seizures:
- Research characterizing patient and caregiver experiences of prolonged seizures describes unmet needs and the significant short-term and long-term negative impact on quality of life.[7]
- Real-world data from Adelphi's Prolonged Seizure Disease Specific Programme™ characterizes the definition, prevalence, and patient population of prolonged seizures finding that people living with epilepsy experiencing prolonged seizures encounter significant seizure worry due to their seizure. In addition, these seizures regularly progress to status epilepticus and/or seizure clusters, leading to emergency care and hospital admissions, despite best practice.[5]
- A post hoc analysis of video-EEG recordings from 725 patients explores seizure duration and time-point cutoffs for statistically defining possible and probable prolonged seizures by seizure type, supporting the 2-minute cutoff for tonic-clonic seizures (focal/generalized onset) and suggesting a 1 to 3 minutes cutoff for other seizures, confirming that most seizure are abnormally prolonged at 2 minutes or less[6]
- Seizure pathways: A qualitative study aimed to understand the end-to-end care process for acute seizure emergencies finding that a stronger focus on outpatient guidelines could empower patients and caregivers to manage prolonged seizures in the outpatient setting, potentially avoiding unnecessary seizure escalation, injury, hospitalization and death.[8]
- Acute medication landscape: A global analysis assessed the availability and reimbursement coverage of seizure acute medications for use in the outpatient setting.[9]
Lennox-Gastaut syndrome:
Diagnosing LGS is challenging due to the heterogeneity of its clinical presentation and symptom evolution over time. A group of ten epilepsy experts from seven countries convened to develop a simple-to-use checklist for non-specialists to support LGS diagnosis, using the International League Against Epilepsy criteria as a framework.[10]
UCB-sponsored symposium: Time matters in developmental and epileptic encephalopathies
- Date: Monday, September 1st, 13:55 – 15:05
- Overview: The upcoming symposium aims to enhance knowledge and awareness of the broader impact of DEEs in adulthood - beyond seizure control. The session will focus on improving diagnosis, understanding treatment journeys and addressing barriers to care in order to drive better individual outcomes.
UCB presentations during the International Epilepsy Congress (IEC) Congress Annual Meeting
Lead Author | Abstract Title |
DEEs | |
Wilkinson AL, et al[3] | Oral presentation: Unpredictable Seizures and Disruptive Behavior in Developmental and |
Specchio N, et al[10] | A checklist to support the diagnosis of Lennox-Gastaut syndrome |
Rodriguez Solis B, et al[4] | Barriers and benefits of identifying patients with DEE in adult care settings |
Soto Insuga V, et al[11] | Improving Lives in Dravet Syndrome: Overcoming Challenges in the Family Journey |
Lothe A, et al[12] | A Retrospective Claims Study Evaluating Mortality in Patients With Lennox-Gastaut or |
Montero V, et al[13] | Lennox-Gastaut Syndrome. Situation analysis and Family Journey. |
Seizures | |
Trinka E, et al[5] | Describing the Population of Patients with Prolonged Seizures: Results from a Global Real-World |
Sile B, et al[6] | Seizure Duration and Time-point Cutoffs for Statistically Defining a Prolonged Seizure: A Post-Hoc |
Kaye D, et al[7] | Characterising Patient and Caregiver Experiences Resulting from Prolonged Seizures |
Sain N, et al[8] | Understanding and Optimising the Seizure Emergency Pathway |
Shafer P, et al[9] | Global Seizure Rescue Medication Landscape: Availability & Reimbursement |
Fenfluramine | |
Nabbout R, et al[14] | Impact of Fenfluramine on Convulsive Seizure Frequency in Dose-Capped Patients With |
Lagae L, at al[15] | A Stratified Analysis of Efficacy and Safety of Fenfluramine in Patients With Dravet Syndrome |
Wirrell E, et al[16] | Oral presentation: Real-World Use of Fenfluramine for Dravet Syndrome: a Retrospective Cohort |
Gjerulfsen CE, et al[17] | Non-seizure benefits of long-term fenfluramine treatment in pediatric patients with Dravet syndrome |
Rosendahl A, et al[18] | Prospective evaluation of non-seizure benefits related to treatment with fenfluramine in pediatric and |
Schoonjans A, et al[2] | Tolerability and Safety of Fenfluramine and Global Functioning of Patients in a Combined Open-label |
Lothe A, et al[19] | A European Study of the Effectiveness of Risk Minimisation Measures for Fenfluramine Oral |
Dransfeld CR, et al[20] | Use of Fenfluramine and Cannabidiol in Daily Practice: A Retrospective Analysis of German |
Mittur A, et al[21] | Exposure-Response Relationships of Fenfluramine in Patients With Dravet Syndrome and |
Zuberi S, et al[22] | Post-hoc Analysis of Fenfluramine for Lennox-Gastaut Syndrome by Baseline Frequency Quartiles |
Early pipeline: | |
Rodriguez N, et al[23] | AAV gene therapy at neonatal age in a mouse model of STXBP1 haploinsufficiency |
Gomes AR, et al[24] | Rescue of neuronal activity in iPSC-derived STXBP1 in vitro disease models using viral vectors |
Niespodziany I, et al[25] | In vitro electrophysiological study of hippocampal network activity in a mouse model of |
Herrewegen YVD, et al[26] | Expression and quantification of STXBP1 splice variants in rodent and primate brain tissues |
Brivaracetam[27] | |
Zafeiriou D, et al.[28] | Brivaracetam Adjunctive Therapy in Paediatric and Adult Patients With Focal-Onset Seizures in |
About UCB
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Important Safety Information about FINTEPLA▼ (fenfluramine) in the EU[1]
Indications: Treatment of seizures associated with Dravet syndrome and Lennox-Gastaut syndrome as an add-on therapy to other anti-epileptic medicines for patients 2 years of age and older.
Dosage and Administration: Please refer to SmPC for full information. Should be initiated and supervised by physicians with experience in the treatment of epilepsy. Fintepla is prescribed and dispensed according to the Fintepla controlled access programme. Dravet syndrome: Patients who are not taking stiripentol: Starting dose is 0.1 mg/kg twice daily (0.2 mg/kg/day). After 7 days, if tolerated, can increase dose to 0.2 mg/kg twice daily (0.4 mg/kg/day). After an additional 7 days, if tolerated and further seizure reduction required, can increase dose to a maximum of 0.35 mg/kg twice daily (0.7 mg/kg/day), which is the recommended maintenance dose. Patients requiring more rapid titration may increase the dose every 4 days. Do not exceed maximum daily dose of 26 mg (13 mg twice daily). Patients who are taking stiripentol: Starting dose is 0.1 mg/kg twice daily (0.2 mg/kg/day). After 7 days, if tolerated, can increase dose to 0.2 mg/kg twice daily (0.4 mg/kg/day), which is the recommended maintenance dose. Patients requiring more rapid titration may increase the dose every 4 days. Do not exceed a total dose of 17 mg (8.6 mg twice daily). Lennox-Gastaut syndrome: Starting dose is 0.1 mg/kg twice daily (0.2 mg/kg/day). After 7 days, the dose should be increased to 0.2 mg/kg twice daily (0.4 mg/kg/day), if tolerated. After an additional 7 days, if tolerated, dose should be increased to 0.35 mg/kg twice daily (0.7 mg/kg/day), which is the recommended maintenance dose. Do not exceed maximum daily dose of 26 mg (13 mg twice daily). Discontinuation: When discontinuing treatment, decrease the dose gradually. As with all anti-epileptic medicines, avoid abrupt discontinuation when possible to minimize the risk of increased seizure frequency and status epilepticus. A final echocardiogram should be conducted 3-6 months after the last dose of treatment with fenfluramine. Renal impairment: Generally, no dose adjustment is recommended when administered to patients with mild to severe renal impairment, however, a slower titration may be considered. If adverse reactions are reported, a dose reduction may be needed. Has not been studied in patients with end-stage renal disease. Not known if fenfluramine or its active metabolite, norfenfluramine, is dialyzable. Hepatic impairment: Hepatic impairment: Generally, no dose adjustment is recommended when Fintepla is administered without concomitant stiripentol to patients with mild and moderate hepatic impairment (Child-Pugh Class A and B). In patients with severe hepatic impairment (Child-Pugh C) not receiving concomitant stiripentol, the maximum dosage is 0.2mg/kg twice daily, and the maximal total daily dose is 17 mg. There are limited clinical data on the use of Fintepla with stiripentol in patients with mild impaired hepatic function. A slower titration may be considered in patients with hepatic impairment and a dose reduction may be needed if adverse reactions are reported. No clinical data is available on the use of Fintepla with stiripentol in moderate and severe hepatic impairment, therefore not recommended for use. Elderly: No data available. Paediatric population: Safety and efficacy in children below 2 years of age not yet established. No data available.
Contraindications: Hypersensitivity to active substance or any excipients. Aortic or mitral valvular heart disease and pulmonary arterial hypertension. Within 14 days of the administration of monoamine oxidase inhibitors due to an increased risk of serotonin syndrome.
Warnings and Precautions: Aortic or mitral valvular heart disease and pulmonary arterial hypertension: Prior to starting treatment, patients must undergo an echocardiogram to establish a baseline and exclude any pre-existing valvular heart disease or pulmonary hypertension. Conduct echocardiogram monitoring every 6 months for the first 2 years and annually thereafter. If an echocardiogram indicates pathological valvular changes, consider follow-up earlier to evaluate whether the abnormality is persistent. If pathological abnormalities seen on echocardiogram, evaluate the benefit versus risk of continuing fenfluramine treatment with the prescriber, caregiver and cardiologist. Once treatment is discontinued for any reasons, a final echocardiogram should be conducted 3-6 months after the last dose of treatment with fenfluramine. If echocardiogram findings suggestive of pulmonary arterial hypertension, perform a repeat echocardiogram as soon as possible and within 3 months to confirm these findings. If echocardiogram finding is confirmed suggestive of an increased probability of pulmonary arterial hypertension defined as intermediate probability, conduct a benefit-risk evaluation of continuation of Fintepla by the prescriber, carer and cardiologist. If echocardiogram suggests a high probability, it is recommended fenfluramine treatment should be stopped. Decreased appetite and weight loss: Fenfluramine can cause decreased appetite and weight loss - an additive effect can occur in combination with other anti-epileptic medicines such as stiripentol. Monitor the patient's weight. Undertake risk-benefit evaluation before starting treatment if history of anorexia nervosa or bulimia nervosa. Fintepla controlled access programme: A controlled access programme has been created to 1) prevent off-label use in weight management in obese patients and 2) confirm that prescribing physicians have been informed of the need for periodic cardiac monitoring in patients taking Fintepla. Somnolence: Fenfluramine can cause somnolence which could be potentiated by other central nervous system depressants. Suicidal behaviour and ideation: Suicidal behaviour and ideation have been reported in patients treated with anti-epileptic medicines in several indications. Advise patients and caregivers to seek medical advice should any signs of suicidal behaviour and ideation emerge. Serotonin syndrome: Serotonin syndrome, a potentially life-threatening condition, may occur with fenfluramine treatment, particularly with concomitant use of other serotonergic agents; with agents that impair metabolism of serotonin such as MAOIs; or with antipsychotics that may affect the serotonergic neurotransmitter systems. Carefully observe the patient, particularly during treatment initiation and dose increases. Increased seizure frequency: A clinically relevant increase in seizure frequency may occur during treatment, which may require adjustment in the dose of fenfluramine and/or concomitant anti-epileptic medicines, or discontinuation of fenfluramine, should the benefit-risk be negative. Cyproheptadine: Cyproheptadine is a potent serotonin receptor antagonist and may therefore decrease the efficacy of fenfluramine. If cyproheptadine is added to treatment with fenfluramine, monitor patient for worsening of seizures. If fenfluramine treatment is initiated in a patient taking cyproheptadine, fenfluramine's efficacy may be reduced. Glaucoma: Fenfluramine can cause mydriasis and can precipitate angle closure glaucoma. Discontinue therapy in patients with acute decreases in visual acuity. Consider discontinuation if ocular pain of unknown origin. Effect of CYP1A2 or CYP2B6 inducers: Co-administration with strong CYP1A2 inducers or CYP2B6 inducers will decrease fenfluramine plasma concentrations, which may lower the efficacy of fenfluramine. If co-administration is considered necessary, the patient should be monitored for reduced efficacy and a dose increase of fenfluramine could be considered provided that it does not exceed twice the maximum daily dose (52 mg/day). If a strong CYP1A2 or CYP2B6 inducer is discontinued during maintenance treatment with fenfluramine, consider gradual reduction of the fenfluramine dosage to the dose administered prior to initiating the inducer. Effect of CYP1A2 or CYP2D6 inhibitors: Initiation of concomitant treatment with a strong CYP1A2 or CYP2D6 inhibitor may result in higher exposure and, therefore, adverse events should be monitored, and a dose reduction may be needed in some patients. Excipients: Contains sodium ethyl para-hydroxybenzoate (E 215) and sodium methyl para-hydroxybenzoate (E 219) - may cause allergic reactions (possibly delayed). It also contains sulfur dioxide (E 220) which may rarely cause severe hypersensitivity reactions and bronchospasm. Patients with rare glucose-galactose malabsorption should not take this medicine. The product contains less than 1 mmol sodium (23 mg) per the maximum daily dose of 12 mL; essentially 'sodium-free'. Contains glucose - may be harmful to teeth. Interactions: Pharmacodynamic interactions with other CNS depressants increase the risk of aggravated central nervous system depression. An increase in dose may be necessary when coadministered with rifampicin or a strong CYP1A2 or CYP2B6 inducer. In in vitro studies coadministration with a strong CYP1A2 or CYP2D6 inhibitor may result in higher exposure (see section 4.4 of the SmPC). Coadministration with CYP2D6 substrates or MATE1 substrates may increase their plasma concentrations. Co-administration with CYP2B6 or CYP3A4 substrates may decrease their plasma concentrations. Pregnancy and lactation: Limited data in pregnant women. As a precaution, avoid use of Fintepla in pregnancy. It is unknown whether fenfluramine/metabolites are excreted in human milk. Animal data have shown excretion of fenfluramine/metabolites in milk. A decision must be made whether to discontinue breast-feeding or to discontinue/abstain from Fintepla taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman. Drive and use machines.: Fintepla has moderate influence on the ability to drive/ use machines as it may cause somnolence and fatigue. Advise patients not to drive or operate machinery until they have sufficient experience to gauge whether it adversely affects their abilities.
Adverse effects: Dravet syndrome: Very common (≥1/10): Upper respiratory tract infection, decreased appetite, somnolence, diarrhoea, pyrexia, fatigue, blood glucose decreased, echocardiogram abnormal (Consisted of trace and mild mitral regurgitation, and trace aortic regurgitation, which are considered physiologic). Common (≥1/100 to <1/10): Bronchitis, abnormal behaviour, aggression, agitation, insomnia, mood swings, ataxia, hypotonia, lethargy, seizure, status epilepticus, tremor, constipation, salivary hypersecretion, weight decreased and blood prolactin increased. Lennox-Gastaut syndrome: Very common (≥1/10): Upper respiratory tract infection, decreased appetite, somnolence, diarrhoea, vomiting, fatigue. Common (≥1/100 to <1/10): Bronchitis, influenza, pneumonia, seizure, status epilepticus, lethargy, tremor, constipation, salivary hypersecretion, blood prolactin increased, weight decreased, fall. Refer to SmPC for other adverse reactions.
▼This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions.
Refer to the European Summary of Product Characteristics for other adverse reactions and full Prescribing Information: https://www.ema.europa.eu/en/documents/product-information/fintepla-epar-product-information_en.pdf.
FINTEPLA® is a registered trademark of the UCB Group of Companies.
Important Safety Information about BRIVIACT® (brivaracetam) in the EU[28]
Therapeutic indications: BRIVIACT is indicated as adjunctive therapy in the treatment of partial-onset seizures with or without secondary generalisation in adults, adolescents and children from 2 years of age with epilepsy.
Posology and method of administration: The physician should prescribe the most appropriate formulation and strength according to weight and dose. It is recommended to parent and care giver to administer BRIVIACT oral solution with the measuring device (10 ml or 5 ml oral dosing syringe) provided in the carton box. BRIVIACT solution for injection/infusion is an alternative route of administration for patients when oral administration is temporarily not feasible. There is no experience with twice daily intravenous administration of brivaracetam for a period longer than 4 days. Adults: The recommended starting dose is 50 or 100 mg/day based on physician's assessment of required for seizure reduction versus potential side effects. Brivaracetam can be taken with or without food. Based on individual patient response and tolerability, the dose may be adjusted in the effective dose range of 50 mg/day to 200 mg/day. Children and adolescents weighing 50 kg or more: The recommended starting dose is 50 mg/day. Brivaracetam may also be initiated at 100 mg/day based on physician's assessment of need for seizure control. The recommended maintenance dose is 100 mg/day. Based on individual patient response, the dose may be adjusted in the effective dose range of 50 mg/day to 200 mg/day. Children and adolescents weighing from 20 kg to less than 50 kg: The recommended starting dose is 1 mg/kg/day. Brivaracetam may also be initiated at doses up to 2 mg/kg/day based on physician's assessment of need for seizure control. The recommended maintenance dose is 2 mg/kg/day. Based on individual patient response, the dose may be adjusted in the effective dose range of 1 mg/kg/day to 4 mg/kg/day. Children weighing from 10 kg to less than 20 kg: The recommended starting dose is 1 mg/kg/day. Brivaracetam may also be initiated at doses up to 2.5 mg/kg/day based on physician's assessment of need for seizure control. The recommended maintenance dose is 2.5 mg/kg/day. Based on individual patient response, the dose may be adjusted in the effective dose range of 1 mg/kg/day to 5 mg/kg/day. For adults, adolescents and children from 2 years of age, the dose should be administered in two equally divided doses, approximately 12 hours apart.
If patients miss one dose or more, it is recommended that they take a single dose as soon as they remember and take the following dose at the usual morning or evening time. Brivaracetam oral solution can be diluted in water or juice shortly before swallowing; a nasogastric tube or a gastrostomy tube may also be used. Brivaracetam may be initiated with either intravenous or oral administration. When converting from oral to intravenous administration or vice versa, the total daily dose and frequency of administration should be maintained. Brivaracetam may be administered as an intravenous bolus without dilution or diluted in a compatible diluent and administered as a 15-minute intravenous infusion. This medicinal product must not be mixed with other medicinal products. Brivaracetam bolus injection or intravenous infusion has not been studied in acute conditions, e.g. status epilepticus, and is therefore not recommended for such conditions. For patients from 16 years of age, if brivaracetam has to be discontinued, it is recommended that the dose is reduced gradually by 50 mg/day on a weekly basis. For patients below the age of 16 years, if brivaracetam has to be discontinued, it is recommended that the dose is reduced by a maximum of half the dose every week until a dose of 1 mg/kg/day (for patients with a body weight less than 50 kg) or 50 mg/day (for patients with body weight of 50 kg or more) is reached. After 1 week of treatment at 50 mg/day, a final week of treatment at 20 mg/day is recommended. No dose adjustment is needed for elderly patients (≥65 years of age) or for those with renal impairment. Based on data in adults, no dose adjustment is necessary in paediatric patients with impaired renal function. No clinical data are available on paediatric patients with renal impairment. Brivaracetam is not recommended for patients with end-stage renal disease undergoing dialysis due to lack of data. Exposure to brivaracetam was increased in patients with chronic liver disease. In patients with hepatic impairment, the following adjusted doses, administered in 2 divided doses, approximately 12 hours apart, are recommended for all stages of hepatic impairment: In adults, adolescents and children weighing ≥50 kg, a 50 mg/day starting dose is recommended, with a maximum daily dose of 150 mg/day. For adolescents and children weighing from 20 kg to <50 kg, a 1 mg/kg/day is recommended, with a maximum daily dose of 3 mg/kg/day. For children weighing from 10 kg to <20 kg, a 1 mg/kg/day is recommended, with a maximum daily dose of 4 mg/kg/day. No clinical data are available in paediatric patients with hepatic impairment. The efficacy of brivaracetam in paediatric patients aged less than 2 years has not yet been established.
Contraindications: Hypersensitivity to the active substance, other pyrrolidone derivatives or any of the excipients. Special warnings and precautions for use: Suicidal ideation and behaviour have been reported in patients treated with anti-epileptic drugs (AEDs) in several indications, including brivaracetam. Patients should be monitored for signs of suicidal ideation and behaviours and appropriate treatment should be considered. Patients (and caregivers) should be advised to seek medical advice should any signs of suicidal ideation or behaviour emerge. Clinical data on the use of brivaracetam in patients with pre-existing hepatic impairment are limited. Dose adjustments are recommended for patients with hepatic impairment. Brivaracetam film-coated tablets contain lactose. Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take brivaracetam. Brivaracetam film-coated tablets, solution for injection/infusion and oral solution contain less than 1 mmol sodium (23mg) per tablet/vial/ml respectively, that is to say essentially 'sodium free'. Brivaracetam oral solution contains 168 mg sorbitol (E420) in each ml. Patients with hereditary fructose intolerance (HFI) should not take this medicinal product. The oral solution contains methyl parahydroxybenzoate (E218), which may cause allergic reactions (possibly delayed). Brivaracetam oral solution contains propylene glycol (E1520).
Interaction with other medicinal products and other forms of interaction: In clinical studies, although patient numbers were limited, brivaracetam had no observed benefit over placebo among patients taking concomitant levetiracetam. No additional safety or tolerability concern was observed. In an interaction study between brivaracetam 200 mg single dose and ethanol 0.6 g/L continuous infusion in healthy volunteers, there was no pharmacokinetic interaction, but the effect of alcohol on psychomotor function, attention and memory was approximately doubled with the intake of brivaracetam. Intake of brivaracetam with alcohol is not recommended. In vitro data suggest that brivaracetam has a low interaction potential. The main disposition pathway of brivaracetam® is by CYPindependent hydrolysis; a second pathway involves hydroxylation mediated by CYP2C19. Brivaracetam plasma concentrations may increase when co-administered with CYP2C19 strong inhibitors (e.g. fluconazole, fluvoxamine), but the risk of a clinically relevant CYP2C19 mediated interaction is considered to be low. Limited clinical data are available implying that coadministration of cannabidiol may increase the plasma exposure of brivaracetam, possibly through CYP2C19 inhibition, but the clinical relevance is uncertain. In healthy subjects, co-administration with the strong enzyme inducer rifampicin (600 mg/day for 5 days), decreased brivaracetam area under the plasma concentration curve (AUC) by
Refer to the European Summary of Product Characteristics for other adverse reactions and full Prescribing Information: https://www.ema.europa.eu/en/documents/product-information/briviact-epar-product-information_en.pdf
BRIVIACT® is a registered trademark of the UCB Group of Companies.
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