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This pooled real-world analysis compared brivaracetam, cenobamate, lacosamide, and perampanel as adjunctive treatments in 1,949 adults with drug-resistant focal epilepsy from 71 epilepsy centers. Lacosamide accounted for 241 prescriptions. Cenobamate demonstrated significantly greater odds of achieving at least a 50% seizure reduction at 6 months compared with lacosamide, with similar advantages for seizure freedom and response at 12 months. However, lacosamide had the lowest incidence of adverse effects among the four treatments, occurring in 14.8% of patients, compared with 57.8% for cenobamate. Treatment retention at 12 months did not significantly differ between cenobamate and lacosamide. The findings therefore position lacosamide as an option with a comparatively favorable tolerability profile, although the study did not demonstrate superior seizure-control effectiveness compared with cenobamate.
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This pooled real-world analysis compared brivaracetam, cenobamate, lacosamide, and perampanel as adjunctive treatments in 1,949 adults with drug-resistant focal epilepsy from 71 epilepsy centers. Lacosamide accounted for 241 prescriptions. Cenobamate demonstrated significantly greater odds of achieving at least a 50% seizure reduction at 6 months compared with lacosamide, with similar advantages for seizure freedom and response at 12 months. However, lacosamide had the lowest incidence of adverse effects among the four treatments, occurring in 14.8% of patients, compared with 57.8% for cenobamate. Treatment retention at 12 months did not significantly differ between cenobamate and lacosamide. The findings therefore position lacosamide as an option with a comparatively favorable tolerability profile, although the study did not demonstrate superior seizure-control effectiveness compared with cenobamate.
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