To assess perampanel (PER) when used as monotherapy in everyday clinical practice.

PER is an anti-seizure medication (ASM) for focal-onset seizures, with or without focal to bilateral tonic-clonic seizures, and generalized tonic-clonic seizures. Information on using PER monotherapy in clinical practice is limited.

Patients treated with PER monotherapy (first-line or conversion to monotherapy) for focal-onset and/or generalized-onset seizures were identified from pooled analysis of 44 clinical practice studies. Retention was assessed after 3, 6 and 12 months of PER treatment. Effectiveness was assessed by seizure type at last visit (last observation carried forward). Effectiveness assessments included seizure freedom rate (no seizures since at least prior visit), and responder rate (≥50% seizure frequency reduction). Safety/tolerability were assessed by adverse events (AEs).  

A total of 268 patients were treated with PER monotherapy at baseline (51.1% female; mean age, 44 years; mean epilepsy duration, 13.2 years). Seizure types at baseline were focal-onset only (75.0%), generalized-onset only (24.5%), and focal-onset and generalized-onset (0.5%). Mean PER doses at baseline and last visit were 3.0 and 5.5 mg/day. Mean number of ASMs received prior to initiating PER monotherapy was 2.7. At last visit, 30.8% of patients were being treated with concomitant ASMs. At 3, 6 and 12 months, retention rates were 91.1% (153/168), 87.3% (138/158) and 73.3% (96/131), respectively. At last visit, seizure freedom rates in patients with focal-onset and generalized-onset seizures were 64.1% and 69.4%, respectively; corresponding responder rates were 84.4% and 93.9%, respectively. AEs were reported for 45.2% of patients; most frequently (≥10% of patients) were dizziness/vertigo (16.8%) and irritability (11.2%). Overall, 13.7% of patients discontinued due to AEs over 12 months.

PER was effective and generally well tolerated when used as monotherapy in clinical practice. At last visit, approximately two-thirds of patients were seizure free.