Added benefit still not proven for epilepsy drug

In continuation of my updates Briviact

Brivaracetam (trade name: Briviact) has been approved since January 2016 as add-on therapy for adults and adolescents from 16 years of age with epileptic seizures. The German Institute for Quality and Efficiency in Health Care (IQWiG) had already examined the drug in an early benefit assessment published in May. For several reasons, the indirect comparisons presented by the drug manufacturer were unsuitable to assess an added benefit in comparison with the appropriate comparator therapy. Among other things, the manufacturer had not analysed all relevant outcomes. In the commenting procedure, the manufacturer presented a further indirect comparison.

In the addendum thereupon commissioned to IQWiG by the Federal Joint Committee (G-BA), the Institute has now concluded that this new indirect comparison is methodologically better. Among other things, the manufacturer has now analysed the missing outcomes. However, this indirect comparison submitted subsequently still fails to show an added benefit of brivaracetam over the appropriate comparator therapy.

New analyses only partly rectify the deficits

In its dossier assessment in May, IQWiG criticized that not all brivaracetam studies presented by the manufacturer were relevant for the benefit assessment, that the studies were insufficiently similar for informative indirect comparisons, that the manufacturer had not presented analyses of all relevant outcomes, and that the comparator therapies had not been recognizably customized for the individual patient, as demanded by the G-BA.

The new indirect comparison submitted subsequently by the manufacturer addresses the first 3 points of criticism. The brivaracetam study is relevant for the research question, the studies used for the comparison are sufficiently similar to this study, and further patient-relevant outcomes are addressed. However, the problem remains unsolved that treatment in the control arms was not customized for the individual patient and thus does not correspond to the appropriate comparator therapy.

Non-inferiority of brivaracetam questionable

Independent of the question as to whether the appropriate comparator therapy specified by the G-BA was implemented, in the overall consideration, the indirect comparison shows no advantage of brivaracetam over lacosamide. Neither advantages nor disadvantages of brivaracetam were shown in the outcome categories "mortality" and "health-related quality of life" in comparison with lacosamide.

In the category "side effects", significant effects were shown in favour of brivaracetam (for serious adverse events and some specific adverse events, such as dizziness or eye disorders). However, the available data on the morbidity outcomes "seizure frequency", "50% responder rate" and "freedom of seizure", raise doubts that brivaracetam is at least equally effective as lacosamide. For seizure frequency, the one lacosamide study fails to show a clear advantage or disadvantage of brivaracetam, while the other shows a statistically significant disadvantage of the new drug compared with lacosamide. Both lacosamide studies also deliver heterogeneous results for the two other outcomes, which, however, do not lead to statistically significant advantages or disadvantages.

Overall, the indirect comparison therefore does not show an advantage of brivaracetam over the comparator therapy.

UCB Announces Briviact (brivaracetam) Now Approved by FDA to Treat Partial-Onset (Focal) Seizures in Pediatric Epilepsy Patients

 In continuation of my update on brivaracetam

UCB announced today that the U.S. Food and Drug Administration (FDA) has approved a supplemental new drug application (sNDA) for the company’s newest anti-epileptic drug (AED) Briviact (brivaracetam) oral formulations indicated as monotherapy and adjunctive therapy in the treatment of partial onset (focal) seizures in patients age four years and older.

This approval provides clinicians with the convenient option to prescribe Briviact to their pediatric patients as a tablet or oral solution, providing flexible administration options which are important considerations when treating children.

As the safety of Briviact injection has not been established in pediatric patients, Briviact injection is indicated for the treatment of partial-onset seizures only in patients 16 years of age and older.

As a result of the FDA’s decision, children age four years and older with partial-onset seizures in the U.S. can now be treated with Briviact. This extends the clinical application for Briviact which already has a similar indication for adults.

Briviact is the newest anti-epileptic drug (AED) in the synaptic vesicle protein 2A (SV2A) family of medicines – a class of medicines discovered and developed by UCB. Briviact demonstrates a high and selective affinity for SV2A in the brain. It is highly permeable and is rapidly and almost completely absorbed which may contribute to its anticonvulsant effects. Gradual dose escalation is not required when initiating treatment with Briviact for monotherapy or adjunctive therapy, allowing clinicians to initiate treatment at a therapeutic dose from day one.

“As a pediatric neurologist, one of the most challenging aspects in treating epilepsy in children is establishing, quickly, which anti-epilepsy drug will support them best in managing their seizures. The impact of poor seizure control can be extremely detrimental – both to overall quality of life for patients and caregivers and for a child’s development. There is a real sense of urgency for parents and healthcare providers to know whether a particular therapeutic approach is likely to be successful, minimizing some of the challenges associated with epilepsy and potentially allowing them to live a normal and active life,” explained Dr. James Wheless, Director, Neuroscience Institute & Le Bonheur Comprehensive Epilepsy Program - Le Bonheur Children’s Hospital. “The availability of an approved treatment option, such as Briviact, has potential to help improve the lives of children and their families by providing an additional choice to support them in their epilepsy journey.”

 Epilepsy in childhood is a complex disorder that can have a significant impact on many aspects of a child's development and function. Pediatric epilepsy is the most common, serious neurological disorder among children and young adults, thought to affect nearly 470,000 children in the U.S.1,2 Social and societal stigma still associated with epilepsy can be especially cruel for children. The prevalence of pediatric epilepsy has been steadily increasing in the U.S.3 Today, it is estimated that nearly 470,000 children in the U.S. under the age of 18 have epilepsy, representing around a quarter of the total worldwide population who develop the condition each year.4 The U.S. Centers for Disease Control and Prevention (CDC) estimate that 0.6 percent of children in the U.S. ages 0 to 17 have active epilepsy – equivalent to six students in a school of 1000.5 Despite its growing prevalence, approximately 10 to 20 percent of pediatric epilepsy patients experience inadequate seizure control with available anti-epileptic drugs.6,7,8 Alongside close partnerships with educators, family members, and healthcare providers, there is a need for newer AEDs with better seizure control which can support and maximize a child’s potential for academic success.

“We believe there is a real need for newer AEDs to support and maximize the potential for success for children with epilepsy,” explained Jeff Wren, Executive Vice-President, Head of UCB’s Neurology Patient Value Unit. “The approval of Briviact in the U.S for pediatric patients represents an important milestone for patients, families, doctors, UCB, and the wider epilepsy community, and has the potential to provide additional value for patients - both today and for their future. We are very excited to be able to provide a new pediatric treatment choice, and we are proud to support patients as they progress on their epilepsy journey.”

The expanded FDA indication for Briviact is based on the principle of extrapolation of its efficacy data from adults to children, and is supported by safety and pharmacokinetics data collected in children. Adverse reactions in pediatric patients are generally similar to those seen in adult patients9. This principle of extrapolating clinical data from well controlled studies in adults has been recognized by the FDA as potentially addressing the challenge of limited pediatric data availability.

The safety and effectiveness of Briviact in the treatment of partial-onset seizures have been established in patients four years of age and older. Use of Briviact in these age groups is supported by evidence from placebo-controlled partial-onset seizure studies of Briviact in adults with additional pharmacokinetic and open-label safety studies in pediatric patients age 4 to younger than 16 years of age. Partial-onset seizures in pediatric patients aged 4 to 16 years of age are similar to those in adults and a similar AED exposure-response relationship has been demonstrated. Weight-based dose adaptations have been established in the pediatric population to achieve similar plasma concentrations as observed in adults. The safety and tolerability profile for Briviact in pediatric patients 4 to 16 years of age is generally similar to that seen with adult patients. 

The most common adverse reactions recorded for adults (at least 5 percent for Briviact and at least 2 percent more frequently than placebo) are somnolence and sedation, dizziness, fatigue, and nausea and vomiting symptoms

FDA Approves Briviact (brivaracetam) to Treat Partial Onset Seizures

The U.S. Food and Drug Administration yesterday approved Briviact (brivaracetam) as an add-on treatment to other medications to treat partial onset seizures in patients age 16 years and older with epilepsy.

Epilepsy is a brain disorder that causes people to have recurring seizures. A seizure is an episode, usually of relatively short duration, of abnormal brain activity. Seizures can cause a variety of symptoms, including uncontrolled movements or spasms, abnormal thinking and behavior, and abnormal sensations. Muscle spasms can be violent, and loss of consciousness can occur. Seizures occur when clusters of nerve cells (neurons) in the brain undergo uncontrolled activation. A partial onset seizure begins in a limited area of the brain.

“Patients can have different responses to the various seizure medicines that are available,” said Billy Dunn, M.D., director of the Division of Neurology Products in the FDA’s Center for Drug Evaluation and Research. “With the approval of Briviact, I am pleased that patients with epilepsy have a new treatment option.”

FDA Approves Briviact (brivaracetam) to Treat Partial Onset Seizures