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A review of the pharmacology and clinical efficacy of brivaracetam

机译:布立西坦的药理作用和临床疗效研究进展

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摘要

Brivaracetam (BRV; Briviact) is a new antiepileptic drug (AED) approved for adjunctive treatment of focal (partial-onset) seizures in adults. BRV is a selective, high-affinity ligand for synaptic vesicle 2A (SV2A) with 15- to 30-fold higher affinity than levetiracetam, the first AED acting on SV2A. It has high lipid solubility and rapid brain penetration, with engagement of the target molecule, SV2A, within minutes of administration. BRV has potent broad-spectrum antiepileptic activity in animal models. Phase I studies indicated BRV was well tolerated and showed a favorable pharmacokinetic profile over a wide dose range following single (10–1,000 mg) and multiple (200–800 mg/day) oral dosing. Three pivotal Phase III studies have demonstrated promising efficacy and a good safety and tolerability profile across doses of 50–200 mg/day in the adjunctive treatment of refractory focal seizures. Long-term data indicate that the response to BRV is sustained, with good tolerability and retention rate. BRV is highly effective in patients experiencing secondarily generalized tonic–clonic seizures. Safety data to date suggest a favorable psychiatric adverse effect profile in controlled studies, although limited postmarketing data are available. BRV is easy to use, with no titration and little drug–drug interaction. It can be initiated at target dose with no titration. Efficacy is seen on day 1 of oral use in a significant percentage of patients. Intravenous administration in a 2-minute bolus and 15-minute infusion is well tolerated. Here, we review the pharmacology, pharmacokinetics, and clinical data of BRV.
机译:Brivaracetam(BRV; Briviact)是一种新的抗癫痫药(AED),被批准用于成人局部(部分发作)癫痫发作的辅助治疗。 BRV是突触小泡2A(SV2A)的选择性,高亲和力配体,其亲和力比左乙拉西坦高15至30倍,左乙拉西坦是第一个作用于SV2A的AED。它具有高脂溶性和快速脑渗透性,在给药后几分钟内即可与目标分子SV2A结合。 BRV在动物模型中具有有效的广谱抗癫痫活性。 I期研究表明,单次口服(10–1,000 mg)和多次(200–800 mg /天)服药后,BRV具有良好的耐受性,并在较宽的剂量范围内显示出良好的药代动力学特征。三项关键的III期研究表明,在难治性局部性癫痫发作的辅助治疗中,每天剂量为50-200 mg / day时,疗效令人鼓舞,并且具有良好的安全性和耐受性。长期数据表明,对BRV的反应是持续的,具有良好的耐受性和保留率。 BRV对经历继发性强直-阵挛性发作的患者非常有效。迄今为止的安全性数据表明,尽管可获得的售后数据有限,但在对照研究中精神病学不良反应良好。 BRV易于使用,无需滴定且几乎没有药物相互作用。它可以在不滴定的目标剂量下启动。很大比例的患者在口服药物的第一天就发现了疗效。 2分钟推注和15分钟输注的静脉内给药是很好的耐受性。在这里,我们回顾了BRV的药理学,药代动力学和临床数据。

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