Comparative Effectiveness of Brivaracetam, Cenobamate, Lacosamide, and Perampanel in Focal Epilepsy

What is the comparative effectiveness and safety of brivaracetam, cenobamate, lacosamide, and perampanel as adjunctive therapies in adults with drug-resistant focal epilepsy?In this pooled analysis of real-world medical record–review studies of 1949 patients with drug-resistant focal epilepsy, cenobamate was associated with higher responder rates and seizure freedom at 6 and 12 months compared with brivaracetam, lacosamide, and perampanel, albeit with a higher incidence of adverse effects.These results suggest that cenobamate offers superior long-term effectiveness over other newer ASMs in drug-resistant focal epilepsy, although its increased risk of adverse effects should be carefully weighed in clinical decision-making.

Corresponding Author: Emanuele Cerulli Irelli, MD, PhD, Department of Human Neurosciences, Sapienza University, Viale dell’Università, 30, Rome 00185, Italy (emanuele.cerulliirelli@uniroma1.it).

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