Abstract Details

Title Outcomes of Intravenous Use of Brivaracetam and Levetiracetam for the Treatment of Seizures in US Hospitals

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) Epilepsy/Clinical Neurophysiology (EEG) Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 135

Objective To compare the effectiveness of intravenous brivaracetam (BRV) vs levetiracetam (LEV) for treatment of seizures within the hospital setting.

Background Injectable antiseizure medications (ASMs), including benzodiazepines (BZDs), are widely used for managing seizures in hospitals. LEV, a SV2A ligand, is a common intravenous ASM. BRV is a newer SV2A ligand approved as a 2 min intravenous bolus for the treatment of focal seizures in adults.

Design/Methods Retrospective cohort analysis was performed using chargemaster data from 860 US hospitals in the Premier Healthcare Database. Adult patients treated intravenously with LEV or BRV with or without BZD and a seizure discharge diagnosis between 01Jul2016-31Dec2019 were included. The cohorts were matched 4:1 on baseline characteristics. Outcomes of interest included intubation rates, intensive care unit (ICU) admission, length of stay (LOS), all-cause and seizure-related readmission, total visit cost, and in-hospital mortality. Multivariable analysis was performed to determine association between treatment and outcomes.

Results A total of 450 patients (LEV, n=360; BRV, n=90) were analyzed. Patient characteristics after matching were similar between the cohorts, except dementia, census region and hospital bed size. Patients treated with intravenous BRV had statistically significant lower prevalence of ICU admission (14.4% vs 24.2%, P≤0.05) and 30-day seizure-related readmissions (0% vs 4.2%, P≤0.05). Intravenous BRV had lower prevalence of clinically relevant outcomes including intubation (0% vs 1.1%, P=0.59) and 30-day all-cause readmissions (1.1% vs 6.4%, P=0.06) although these were not significant. Total visit costs (P=0.91), LOS (P=0.35), and in-hospital mortality (P=0.77) were similar. Adjusted odds for ICU admission was 47% lower for patients treated with intravenous BRV vs intravenous LEV (P≤0.05).

Conclusions Use of intravenous BRV may provide an alternative to intravenous LEV for the management of seizures in the hospital setting due to lower prevalence of ICU admission, intubation, and 30-day seizure-related readmissions. Larger controlled studies are needed to confirm these preliminary findings.

Authors/Disclosures
Prashant Dongre, MD, MBBS (UCB Inc) PRESENTER	Dr. Dongre has received personal compensation for serving as an employee of UCB Inc. Dr. Dongre has stock in UCB Inc.
	No disclosure on file
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Abstract Details