Efficacy and safety of perampanel for epilepsy: a systematic review and meta-analysis of real-world studies

OBJECTIVE: The aim of the study was to summarize the findings of the studies doc-umenting the efficacy and safety of perampanel when used in children/adolescents or adults, ei-ther as add-on therapy or as monotherapy.MATERIALS AND METHODS: A systematic search was conducted using PubMed, EMBASE and Scopus. Only studies with a cohort-based ap-proach (either prospective or retrospective) were included. We were interested in real-world stud-ies and therefore, studies with a highly regulated environment, such as randomized controlled tri-als, were excluded. The primary outcomes of in-terest were retention rates, response rates and seizure-free rates. Random effects model was used for the analysis. Effect sizes were reported as pooled prevalence along with 95% confidence intervals.RESULTS: A total of 34 studies were included. The retention rates, within 24 months from initi-ation of treatment as an add-on therapy, ranged between 65% to 77% among children and ado-lescents. For adults, the retention rate varied be-tween 56 to 77% within 24 months from initiation of treatment. The response rate was around 70% in children/adolescents and 52% in adults at 24 months of follow-up. Around 25% of children and adolescents and 37% of adults were seizure-free at 24 months follow-up period. The proportion of children/adolescents and adults reporting any treatment-related adverse effects was 29% and 41%, respectively. The commonly reported ad-verse effects were dizziness/drowsiness, somno-lence, behavioral problems (irritability, aggres-sion, anxiety, mood changes), postural instabili-ty/gait problems, fatigue and weight gain.CONCLUSIONS: Perampanel might be an ef-fective anti-epileptic drug in both children/ad-olescents and adults when used as an adjunct therapy. More data is required to comment on its use as monotherapy. Careful monitoring for psy-chiatric problems and behavioral disturbances is required, both prior to initiating treatment as well as during the course of management. Stud-ies with long-term follow-up may are needed to confirm the findings of this meta-analysis.