Lacosamide And Brivaracetam Show Similar Short-Term Results

What was studied

Researchers combined results from randomized, double-blind studies that tested two add-on seizure medicines, lacosamide (LCM) and brivaracetam (BRV), in adults and older teens with drug-resistant focal epilepsy. All participants were age 16 or older, and the medicines were used as adjunctive therapy, meaning they were added to other seizure medicines people were already taking.

The analysis included 8 placebo-controlled trials with 3,338 participants in the primary 50% responder analysis. The researchers did not compare LCM and BRV head-to-head in the same trial. Instead, they compared each drug with placebo and then used placebo as the link to estimate how LCM and BRV compared with each other.

What they found

This analysis did not find a clear difference between lacosamide and brivaracetam for short-term seizure outcomes. The chance of having at least a 50% drop in seizures looked similar between the two drugs. Seizure freedom also did not clearly differ, but the estimate was very uncertain.

Overall side effects reported during treatment were also similar. Serious side effects were numerically higher with lacosamide, but the results were too uncertain to draw clear conclusions. Stopping treatment because of side effects was also imprecise.

Exploratory analyses in Asian participants and in dose-aligned groups also did not show a clear difference, but those analyses were limited by sparse events and imprecision.

Limits of the evidence

This study cannot show that the two medicines are truly equal. It was an indirect comparison, not a direct trial where people were randomly assigned to lacosamide or brivaracetam in the same study.

The certainty of the evidence was generally low for the main indirect comparisons. Many results were imprecise, which means the true difference could still favor either drug. Some outcomes, especially seizure freedom and serious side effects, had wide confidence intervals. The findings also apply to short-term results in people age 16 and older with drug-resistant focal epilepsy, so they may not apply to younger children, other seizure types, or long-term treatment.

For families and caregivers

For families, this study suggests that current randomized evidence does not clearly show that one of these two add-on medicines works better than the other for adults with drug-resistant focal epilepsy. It also does not clearly show a comparative safety advantage overall.

That means treatment choices may still depend on other factors, such as a person’s other health conditions, possible side effects, other medicines they take, cost, and discussion with their epilepsy clinician.

What to watch next

Direct head-to-head randomized trials of lacosamide versus brivaracetam are needed. Longer follow-up and clearer side-effect reporting would also help strengthen the evidence.

Terms in this summary

adjunctive therapy

A treatment added on to medicines a person is already taking.

drug-resistant focal epilepsy

Focal epilepsy in which seizures continue despite trying appropriate seizure medicines.

placebo

A look-alike treatment with no active medicine, used for comparison in studies.

randomized trial

A study where participants are assigned by chance to different treatments.

network meta-analysis

A method that compares treatments across different studies, even when the treatments were not tested directly against each other.

risk ratio

A number that compares how often an outcome happens in one group versus another.

confidence interval

A range that shows how uncertain a study result is.

imprecision

Uncertainty in the results, often because there were not enough events or participants.