Perampanel在脑肿瘤相关癫痫患者辅助治疗中的应用:真实世界数据

Q4 Medicine
G. G. Samsonova, I. Zhidkova
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引用次数: 0

摘要

背景。脑肿瘤相关性癫痫(BTRE)是一个重要但研究不足的跨学科问题。在很大一部分脑肿瘤患者中,疾病以癫痫发作为首发。肿瘤相关性癫痫的病程往往是耐药的,需要合理的综合治疗。迄今为止,对于BTRE的初始治疗选择抗癫痫药物(AED)尚无统一的建议。目的:回顾性分析perampanel辅助治疗与神经胶质性脑肿瘤和转移性癫痫患者癫痫发作相关的疗效/耐受性。材料和方法。该分析包括51例神经胶质肿瘤和脑转移患者,他们将perampanel作为辅助治疗的一部分。在>1个月、≥3个月、≥6个月的随访期间评估其对局灶性癫痫发作(FS)和双侧强直-阵挛性癫痫发作(BTCS)的疗效。分析发作频率降低50%或更多(反应者)或100%(发作自由)。对多因子模型中干预因素的影响进行了分析,对perampanel的整体有效性进行了评估,并对干预因素进行了分层评估。我们还评估了不良事件(ae)的频率和特征,包括它们与其他aed使用的可能关联。在多因素模型中,临床效果的独立预测因子是在>1个月≥3个月≥6个月的随访中以FS形式出现疾病。在一线治疗中使用的aed均未对临床效果产生影响。在整个随访期间,BTCS患者的临床效果没有预测因素。51例患者中48例(94.1%)有应答,其中36例(70.6%)癫痫发作无发作记录。在FS患者中,不同随访期应答者的比例为83.3-90.9%,其中31.2-50.0%表现癫痫发作自由。在BTCS患者中,86.7-92.3%成为应答者,其中56.1-88.5%实现癫痫发作自由。不良事件7例(13.7%),最常见的为攻击性事件4例(7.8%)。没有病例由于不良反应而需要减少剂量或停止使用perampanel治疗。在大多数患者>1≥3≥6个月的随访中,中位数为6mg /天。在现实世界的实践中进行的研究证实了perampanel在神经胶质性脑肿瘤和转移性癫痫发作的辅助治疗中的高效率和安全性,再加上药物相互作用的低潜力,使我们能够向这类患者推荐该药。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Perampanel in adjunctive therapy of patients with brain tumor-related epilepsy: real-world data
Background. Brain tumor-related epilepsy (BTRE) is an important and insufficiently studied interdisciplinary problem. In a significant part of brain tumor patients, the disease onsets with epileptic seizures. The course of tumor-associated epilepsy is often pharmacoresistant and requires rational polytherapy. To date, there are no uniform recommendations on the choice of an antiepileptic drug (AED) for the initial therapy of BTRE.Objective: retrospective analysis of the efficacy/tolerability of adjunctive therapy with perampanel in relation to epileptic seizures in patients with epilepsy associated with glial brain tumors and metastases.Material and methods. The analysis included 51 patients with glial tumors and brain metastases who were prescribed perampanel as part of adjunctive therapy. Its effectiveness against focal seizures (FS) and bilateral tonic-clonic seizures (BTCS) was evaluated at follow-up periods of >1≥3≥6 months. A decrease in the frequency of seizures by 50% or more (responders) or by 100% (seizure freedom) was analyzed. An analysis of the influence of intervening factors in a multifactorial model, an assessment of the effectiveness of perampanel as a whole and a stratified assessment of intervening factors were carried out. The frequency and profile of adverse events (AEs) were also evaluated, including their possible association with the use of other AED.Results. In the multifactorial model, independent predictors of the clinical effect were the onset of the disease in the form of FS at >1≥3≥6 months follow-up. None of AEDs used in the first line of therapy demonstrated an impact on the clinical effect. There were no predictors of clinical effect in patients with BTCS during the entire follow-up period. Out of 51 patients, 48 (94.1%) were responders, and in 36 of them (70.6%) the seizure freedom was registered. Among patients with FS, the proportion of responders was 83.3–90.9% at different follow-up periods, including 31.2–50.0% who showed seizure freedom. Among patients with BTCS, 86.7–92.3% became responders, including 56.1–88.5% who achieved seizure freedom. AEs were noted in 7 (13.7%) patients, the most common was aggression – 4 patients (7.8%). There were no cases required reduction the dose or discontinuation the treatment with perampanel due to AEs. In most patients at >1≥3≥6 months follow-up, the median was 6 mg/day.Conclusion. The study performed in real-world practice confirmed the high efficiency and safety of perampanel in the adjunctive therapy of epileptic seizures associated with glial brain tumors and metastases, which together with the low potential of drug interactions allow us recommend the drug to this contingent of patients.
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来源期刊
Epilepsy and Paroxysmal Conditions
Epilepsy and Paroxysmal Conditions Medicine-Neurology (clinical)
CiteScore
0.90
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0.00%
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31
审稿时长
8 weeks
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