Real-World Practice: Perampanel for Partial-Onset Seizures

Expert experience regarding the use of perampanel to treat uncontrolled partial-onset seizures in clinical practice and advantages to using the drug over other treatment options.

Amit Verma, MD: In our practice, we’ve used quite a bit of perampanel. We’ve used the drug as adjunctive treatment. But also, over the last several years, we’ve used it much earlier. We’ve used it as first-line therapy and even as monotherapy.

There are advantages associated with using perampanel. If you dose it appropriately, meaning if you go slow on the titration schedule, patients tend to tolerate the medication well. You can see good efficacy. A high percentage of patients become seizure-free, even at low doses—4 or 6 mg. We’ve seen this when the drug is used as the first add-on therapy as well as when it is used as monotherapy. We certainly are very comfortable using it.

The advantage of using a long half-life medication is that if somebody misses their dose, serum levels really don’t drop as much as if you were using the drug with a much shorter half-life. If you look at patient compliance information, patients tend to be 70% compliant to their medications. This has been shown by numerous studies over the decades. So anything that we can use that has a long half-life really has the potential to reduce the risk of breakthrough seizures and so on. 

We want to pick something that has a long half-life and that has proven efficacy for partial-onset seizures but really, more important, partial-onset seizures that have secondary generalization. The medication was really shown to be very effective in that particular group.

Our experience using perampanel has been very good. As I mentioned, we’ve used the drug as first-line treatment after first monotherapy failure and as initial monotherapy. The percentage of patients who have either had a significant reduction in their seizures or have become seizure-free is really quite high. It compares, to a large extent, to the results of clinical studies. Thus, we’ve felt very comfortable using the drug and are very happy using it for that particular situation. Given its efficacy for secondary generalized seizures, it really makes a lot of sense to use a medication like this, which has proven efficacy in addition to a long half-life.

As people have gotten more comfortable using Fycompa [perampanel] over time, more physicians are beginning to use it early on in the management of their patients. It is being used as add-on therapy and as initial monotherapy. The efficacy data support its use in those particular instances, with a very high percentage of patients becoming seizure-free. The fact that the half-life is so long is yet another advantage of using the medication in that particular instance. Efficacy was even seen at low doses—4 and 6 mg. That allows us to reach targeted doses relatively quickly in patients, and it also allows us to minimize some of the adverse effects that we might otherwise see at higher doses.