What is the expected rate of seizures when switching a patient from Keppra (levetiracetam) to Briviact (brivaracetam)?

Seizure Risk When Switching from Keppra (Levetiracetam) to Briviact (Brivaracetam)

When switching from Keppra (levetiracetam) to Briviact (brivaracetam), patients can expect a similar seizure control rate with potential improvement in neuropsychiatric side effects in approximately 76% of cases. 1

Efficacy Comparison Between Levetiracetam and Brivaracetam

Brivaracetam is a newer antiseizure medication that is structurally related to levetiracetam but has a more selective action on the synaptic vesicle glycoprotein 2A binding site. This selectivity appears to provide similar seizure control with potentially improved tolerability:

• Clinical studies show that when switching from levetiracetam to brivaracetam:

  • 61% of patients maintain stable seizure frequency
  • 26.8% experience improved seizure control
  • 12.2% experience worsened seizure control 1

• In pediatric populations, brivaracetam has shown efficacy even in patients who previously failed levetiracetam therapy, with a responder rate (≥50% seizure reduction) of 45.2% 2

Switching Protocol and Safety

The FDA-approved brivaracetam label provides important information regarding the transition:

• An overnight switch from levetiracetam to brivaracetam is generally safe and well-tolerated 1
• No titration period is required when initiating brivaracetam treatment 3
• The clinical studies supporting brivaracetam approval showed significant seizure reduction over placebo, with 25.2% reduction at 100 mg/day and 25.7% reduction at 200 mg/day 3

Important Consideration

The FDA label specifically notes: "Although patients on concomitant levetiracetam were excluded from Study 3, which evaluated 100 and 200 mg daily, approximately 54% of patients in this study had prior exposure to levetiracetam." This suggests that brivaracetam can be effective in patients previously treated with levetiracetam 3

Potential Adverse Effects

When switching to brivaracetam, patients may experience:

• Brivaracetam-related adverse events in approximately 24.4% of cases 1
• Common adverse effects include:
  • Mild somnolence (6.4%)
  • Psychosis (3.2%)
  • Nausea (3.2%) 2

Neuropsychiatric Profile

One of the most significant benefits of switching from levetiracetam to brivaracetam is the improvement in neuropsychiatric side effects:

• 76% of patients with levetiracetam-related neuropsychiatric adverse events experience improvement after switching to brivaracetam 1
• This makes brivaracetam a particularly good option for patients experiencing behavioral side effects on levetiracetam

Monitoring and Follow-up

When switching patients from levetiracetam to brivaracetam:

1. Monitor for seizure breakthrough in the first few weeks after transition
2. Assess for improvement in any pre-existing levetiracetam-related neuropsychiatric side effects
3. Be aware that approximately 19.5% of patients may require discontinuation of brivaracetam 1
4. Consider that some patients (12.2%) may experience worsening seizure control and require adjustment or switch back to levetiracetam

Practical Considerations

• For patients with neuropsychiatric side effects from levetiracetam, brivaracetam offers a high likelihood of improvement (76%) while maintaining seizure control
• The ability to switch overnight without titration simplifies the transition process
• Patients should be counseled about the small risk of seizure worsening (12.2%) when making the switch

While some older studies raised concerns about generic substitutions of levetiracetam 4, 5, more recent evidence suggests bioequivalence between brand and generic levetiracetam 6. However, this is less relevant when switching to brivaracetam, which is a different medication with its own unique profile.