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Abstract Details

Post-hoc Analysis of the Effects of Dose Reductions of Concomitant Clobazam in a Phase 3, Open-Label Study of Cenobamate for the Treatment of Uncontrolled Focal Seizures
Epilepsy/Clinical Neurophysiology (EEG)
Epilepsy/Clinical Neurophysiology (EEG) Posters (7:00 AM-5:00 PM)
015
Report on post-hoc analyses of how dose adjustments to concomitant clobazam impacted efficacy and tolerability in an ongoing, phase 3 study (N=1347) of adjunctive cenobamate, an FDA-approved antiseizure medication (ASM) for uncontrolled focal seizures.
Clobazam’s active metabolite, N-desmethylclobazam, is metabolized by CYP2C19; cenobamate inhibits CYP2C19, which may increase N-desmethylclobazam plasma levels.
Patients with uncontrolled focal seizures taking 1-3 ASMs were enrolled. Increasing doses of cenobamate were administered (12.5, 25, 50, 100, 150, 200 mg/day) biweekly; increases to 400 mg/day by 50-mg/day biweekly were permitted. Adjustments to concomitant ASMs were allowed.

N=240 patients had available data and 177 remained on cenobamate (73.8% retention). 38 patients received concomitant clobazam at baseline; mean clobazam dose in ongoing cenobamate patients (n=30) decreased from 38.0 mg to 12.7 mg (initial to last dose) and 8/30 patients (26.7%) discontinued clobazam. In n=8 patients who discontinued cenobamate, clobazam dose was decreased less (35.6 mg to 24.4 mg). Among ongoing cenobamate patients who had clobazam dose decreases (n=25), the dose reductions occurred at mean visit 7.6 (~Week 10) and mean cenobamate dose at time of clobazam dose adjustment was 135.0 mg. Clobazam doses were decreased most often due to AEs (eg, tiredness/fatigue, sleepiness/drowsiness, slurred speech). 60/177 cenobamate patients (33.9%) were seizure-free ≥12 months and 6/60 (10.0%) were on concomitant clobazam, which is somewhat less than the percentage on concomitant clobazam of all patients (15.8%), those continuing cenobamate (16.9%), or those who discontinued cenobamate (12.7%). In 7 patients who discontinued clobazam, seizures reoccurred/worsened, and clobazam was resumed at lower doses (2.5-10 mg/day vs prior mean 32.9 mg/day) to improve seizure control.

In this post-hoc analysis, patients who remained on cenobamate had greater dose reductions in concomitant clobazam vs those who discontinued cenobamate. Concomitant clobazam dose reductions should be considered in patients taking adjunctive cenobamate.
Authors/Disclosures
Bassel W. Abou-Khalil, MD, FÂé¶¹´«Ã½Ó³»­ (Vanderbilt University)
PRESENTER
The institution of Dr. Abou-Khalil has received research support from Cerevel. The institution of Dr. Abou-Khalil has received research support from Xenon. The institution of Dr. Abou-Khalil has received research support from Otsuka. The institution of Dr. Abou-Khalil has received research support from UCB. The institution of Dr. Abou-Khalil has received research support from SK LIfe Science. The institution of Dr. Abou-Khalil has received research support from Neuroelectrics.
Louis Ferrari (SK Lifescience) Louis Ferrari has received personal compensation for serving as an employee of SK Life science.
Pavel Klein, MD, FÂé¶¹´«Ã½Ó³»­ (Mid-atlantic Epilepsy and Sleep Center) The institution of Dr. Klein has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Aquestive. The institution of Dr. Klein has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Neurelis. The institution of Dr. Klein has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for UCB Pharma. The institution of Dr. Klein has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for SK Life Sience. The institution of Dr. Klein has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Eisai. The institution of Dr. Klein has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. The institution of Dr. Klein has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Alliance. The institution of Dr. Klein has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Arvelle Therapeutics. Dr. Klein has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Aquestive. Dr. Klein has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Eisai. Dr. Klein has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for UCB Pharma. Dr. Klein has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for SK Life Sciences. Dr. Klein has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Sunovion. Dr. Klein has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for PrevEp. Dr. Klein has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Fenwick . Dr. Klein has received research support from DOD/CURE.
No disclosure on file
Gregory Krauss, MD (Johns Hopkins University) Dr. Krauss has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Arvelle. Dr. Krauss has received stock or an ownership interest from EpiWatch.
David G. Vossler, MD, FÂé¶¹´«Ã½Ó³»­ (David G. Vossler MD FÂé¶¹´«Ã½Ó³»­ FAES FACNS) Dr. Vossler has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Longboard Pharmaceuticals. Dr. Vossler has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Xenon Pharmaceuticals. Dr. Vossler has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for SK Life Science. The institution of Dr. Vossler has received research support from Xenon Pharmaceuticals. The institution of Dr. Vossler has received research support from Longboard Pharmaceuticals. Dr. Vossler has received publishing royalties from a publication relating to health care.
Michael R. Sperling, MD, FÂé¶¹´«Ã½Ó³»­ (Thomas Jefferson University) Dr. Sperling has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurelis. The institution of Dr. Sperling has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic. Dr. Sperling has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for UCB Pharma. Dr. Sperling has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Medscape. Dr. Sperling has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for International Medical Press. Dr. Sperling has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Projects for Knowledge. The institution of Dr. Sperling has received research support from SK Life Science. The institution of Dr. Sperling has received research support from UCB Pharma . The institution of Dr. Sperling has received research support from Takeda. The institution of Dr. Sperling has received research support from Neurelis. The institution of Dr. Sperling has received research support from Engage Therapeutics . The institution of Dr. Sperling has received research support from Medtronic. The institution of Dr. Sperling has received research support from Cavion. The institution of Dr. Sperling has received research support from Xenon Pharma. The institution of Dr. Sperling has received research support from Cerevel. The institution of Dr. Sperling has received research support from National Institutes of Health . The institution of Dr. Sperling has received research support from DARPA. Dr. Sperling has received publishing royalties from a publication relating to health care. Dr. Sperling has received publishing royalties from a publication relating to health care. Dr. Sperling has received personal compensation in the range of $500-$4,999 for serving as a Vice President with Epilepsy Consortium .
William E. Rosenfeld, MD, FÂé¶¹´«Ã½Ó³»­ (Comprehensive Epilepsy Care Center for Children and Adults) The institution of Dr. Rosenfeld has received personal compensation in the range of $500,000-$999,999 for serving as a Consultant for SK Life Science. Dr. Rosenfeld has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for SK Life Science.