Newly published data evaluates the safety and efficacy of adjunctive perampanel for idiopathic generalised epilepsy

Posted in News Review on 24th Aug 2015

Global Phase III Study Data for Fycompa® (Perampanel) in Primary Generalised Tonic-Clonic Seizures Now Published in Neurology

Pivotal, global phase III study results for Fycompa® (perampanel) in primary generalised tonic-clonic (PGTC) seizures have been published for the first time today (24th August 2015) in Neurology.[1] Study 332 assesses the safety and efficacy of perampanel compared to placebo, in primary generalised tonic-clonic (PGTC) seizures in idiopathic generalised epilepsy (IGE). Perampanel, which received the new indication from the European Commission (EC) on 24 June 2015, is the first new treatment for PGTC seizures in five years.[2]

One third more patients treated with perampanel experience a 50% responder rate, which is statistically significant versus placebo (50% responder rate 64.2% vs 39.5%, respectively; P=0.0019).[1] Perampanel also demonstrates a reduction in PGTC seizure frequency (per 28 days) versus placebo (76.5% vs 38.4%, respectively; P<0.0001).[1] Furthermore, 31% of patients are seizure free during the 13-week maintenance period when treated with perampanel as an adjunctive therapy, compared to 12% in the placebo group.[3] The adverse event profile is similar to that for other perampanel studies, the most common treatment-emergent adverse events were dizziness, fatigue, headache, somnolence and irritability.[1]

This is the only study in which the presence of IGE with PGTC seizures was confirmed by an independent expert committee. The study shows that perampanel is well tolerated and improves the control of PGTC seizures in patients who are still experiencing seizures despite their current treatment. The results indicate that perampanel can be considered a broad-spectrum AED, so effective with both focal- and generalised-onset seizures.” comments Christian Brandt, Head of Dept. of General Epileptology, Bethel Epilepsy Centre.

Study 332 was conducted amongst 164 patients aged 12 years and older with IGE who experience PGTC seizures who receive one to a maximum of three anti-epileptic drugs across centres in Europe, the U.S., Japan and Asia.[1]

Generalised tonic-clonic seizures can be a dangerous type of epilepsy,[4] which increase the risk of injury, such as fractured bones, shoulder dislocation and burns.[5] PGTC seizures also increase the risk of sudden unexplained death in epilepsy (SUDEP) and are known to lead to absence status epilepticus (ASE), seizures that last for extended time periods. The seizures start with a loss of consciousness and a sudden contraction of the muscles, which can cause the person to fall down (tonic phase). This is followed by violent convulsions (clonic phase) until the muscles finally relax. While the seizure generally only lasts a few minutes, the person will often feel confused or drowsy for a few minutes or up to a few days before returning to normal.[4],[6] Despite treatment, around 20% of people with idiopathic generalised epilepsy remain uncontrolled.[7]

Perampanel is the only licensed anti-epileptic drug (AED) to selectively target initiation and spread of seizures through inhibition of AMPA receptors, a protein in the brain which plays a critical role in the spread of seizures.[8] In addition to PGTC seizures in IGE, perampanel was originally indicated for the adjunctive treatment of partial-onset seizures, with or without secondarily generalised seizures, in patients with epilepsy aged 12 years and older.[9]

References

  1. French JA et al. Perampanel for tonic-clonic seizures in idiopathic generalized epilepsy: A randomized trial. Neurology 2015. Available at: http://m.neurology.org/content/early/2015/08/21/WNL.0000000000001930.abstract?sid=a7fb2575-996d-4854-8c6c-ac5c791191d2. Last Accessed August 2015
  2. Eisai. Data on file. 2015
  3. French J et al. Adjunctive Perampanel RCT for PGTC seizures. Association of British Neurologists annual meeting 2015; Abstract #53141
  4. Epilepsy Foundation. Types of seizures. Available at: http://www.epilepsy.com/learn/types-seizures. Last Accessed May 2015
  5. Asadi-Pooya AA et al. Physical injuries in patients with epilepsy and their associated risk factors. Seizure 2012 Apr;21(3):165-8
  6. Epilepsy Foundation. IGE Summary. Available at: http://www.epilepsy.com/information/professionals/about-epilepsy-seizures/idiopathic-generalized-epilepsies. Last Accessed July 2015
  7. Faught E. Treatment of refractory primary generalized epilepsy. Rev Neurol Dis 2004;1:S34-S43
  8. Rogawski MA. Revisiting AMPA receptors as an antiepileptic drug target. Epilepsy Currents 2011;11:56-63.9.
  9. Eisai Data on File, 2015
  10. Pugliatti M et al. Estimating the cost of epilepsy in Europe: A review with economic modeling. Epilepsia 2007: 48(12) 2224 – 2233
  11. Smithson WH et al, Curr Neurol Neurosci Rep 2014 Dec; 14(12):502
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