WRAPPER study: Real‐world effectiveness and tolerability of adjunctive perampanel for people with drug–resistant epilepsy in Hong Kong.

Objective: The Prince of Wales Hospital (PWH) Real‐world Analysis of People with Drug‐Resistant Epilepsy (DRE) on PERampanel (WRAPPER) study assessed effectiveness and tolerability of adjunctive perampanel in people with DRE attending PWH. Methods: This was a prospective single‐center real‐world observational study involving 70 people with DRE between July 2016 and June 2021. A post hoc analysis after the initial study period of 16 weeks assessed outcomes for an extended period up to 52 weeks. Results: After 16 weeks, median dose of perampanel was 2 mg (IQR 24 mg). 50% responder rates were 40.0%, 41.5%, and 48.7% at 16, 26, and 52 weeks. Seizure freedom was 12.9%, 20.7%, and 25.6% at 16, 26, and 52 weeks. Monthly seizure frequency reduced from 3.0 (IQR 3.0–6.6) at baseline to 2.0 (IQR 2.0–6.0, p = 0.005) at 16 weeks; 2.0 (IQR 2.0–5.0, p = 0.01) at 26 weeks; and 2.0 (IQR 0.0–4.0, p = 0.018) at 52 weeks. Older age predicted 50% responders (OR 1.08, 95% CI 1.01–1.14, p = 0.048). At 16 weeks, 51.4% (36/70) had treatment‐emergent adverse effects (TEAEs). Most common was seizure exacerbation at 35.7% (25/70) followed by fatigue at 15.7% (11/70). NPI‐12 and ZBI scores indicated no increase in neuropsychiatric symptoms on perampanel. Significance: Low‐dose 2–4 mg adjunctive perampanel for people with DRE conferred appreciable improvements in seizure reduction without significant neuropsychiatric adverse effects in the real‐world setting at a tertiary center in Hong Kong and had better antiseizure effect with advancing age. Plain Language Summary: This real‐world study from Hong Kong found low‐dose perampanel was effective and tolerable for people with drug‐resistant epilepsy. Furthermore, perampanel was also potentially more effective with advancing age. [ABSTRACT FROM AUTHOR]