LAUSR

Commentary Brivaracetam (BRV) is the latest antiepileptic drug to reach the marketplace, and many clinicians are contemplating how they will use it, and in whom. BRV is a close cousin of levetiracetam (LEV), and both drugs are known to bind to the SV2A receptor. BRV binds to the SV2A receptor with an affinity that is 15to 30-fold greater than LEV, although the interaction with the receptor may not be identical. In some animal models, BRV provides superior efficacy compared with LEV at maximum doses (1). Whether these differences will translate to an advantage over LEV in the clinic is uncertain. Since none of the phase III trials included a LEV comparison arm, the relative efficacy and tolerability of the two compounds remain unknown. Many prescribers will try to inform themselves by reading the available literature. Ben-Menachem and colleagues have made this task somewhat easier by providing a pooled analysis of the three pivotal phase III trials that led to the regulatory approval of BRV. This useful article provides information on the efficacy and tolerability seen in the three studies. The efficacy, at face value, is in line with many recently approved drugs, whereas tolerability appears somewhat better, at least at higher doses, with overall fewer dropouts because of adverse events (2). When reviewing this data, clinicians will be looking for answers to pragmatic questions that can inform the use of the drug. Several of these are discussed below.