Sustained seizure freedom with adjunctive brivaracetam in patients with focal onset seizures

The maintenance of seizure control over time is a clinical priority in patients with epilepsy. The aim of this study was to assess the sustained seizure frequency reduction with adjunctive brivaracetam (BRV) in real-world practice. Patients with focal epilepsy prescribed add-on BRV were identified. Study outcomes included sustained seizure freedom and sustained seizure response, defined as a 100% and a ≥50% reduction in baseline seizure frequency that continued without interruption and without BRV withdrawal through the 12-month follow-up. Nine hundred ninety-four patients with a median age of 45 (interquartile range = 32–56) years were included. During the 1-year study period, sustained seizure freedom was achieved by 142 (14.3%) patients, of whom 72 (50.7%) were seizure-free from Day 1 of BRV treatment. Sustained seizure freedom was maintained for ≥6, ≥9, and 12 months by 14.3%, 11.9%, and 7.2% of patients from the study cohort. Sustained seizure response was reached by 383 (38.5%) patients; 236 of 383 (61.6%) achieved sustained ≥50% reduction in seizure frequency by Day 1, 94 of 383 (24.5%) by Month 4, and 53 of 383 (13.8%) by Month 7 up to Month 12. Adjunctive BRV was associated with sustained seizure frequency reduction from the first day of treatment in a subset of patients with uncontrolled focal epilepsy

Adjunctive Brivaracetam in Focal Epilepsy: Real-World Evidence from the BRIVAracetam add-on First Italian netwoRk STudy (BRIVAFIRST)

Background: In randomized controlled trials, add-on brivaracetam (BRV) reduced seizure frequency in patients with drug-resistant focal epilepsy. Studies performed in a naturalistic setting are a useful complement to characterize the drug profile. Objective: This multicentre study assessed the effectiveness and tolerability of adjunctive BRV in a large population of patients with focal epilepsy in the context of real-world clinical practice. Methods: The BRIVAFIRST (BRIVAracetam add-on First Italian netwoRk STudy) was a retrospective, multicentre study including adult patients prescribed adjunctive BRV. Patients with focal epilepsy and 12-month follow-up were considered. Main outcomes included the rates of seizure‐freedom, seizure response (≥ 50% reduction in baseline seizure frequency), and treatment discontinuation. The incidence of adverse events (AEs) was also considered. Analyses by levetiracetam (LEV) status and concomitant use of strong enzyme-inducing antiseizure medications (EiASMs) and sodium channel blockers (SCBs) were performed. Results: A total of 1029 patients with a median age of 45 years (33–56) was included. At 12 months, 169 (16.4%) patients were seizure-free and 383 (37.2%) were seizure responders. The rate of seizure freedom was 22.3% in LEV-naive patients, 7.1% in patients with prior LEV use and discontinuation due to insufficient efficacy, and 31.2% in patients with prior LEV use and discontinuation due to AEs (p < 0.001); the corresponding values for ≥ 50% seizure frequency reduction were 47.9%, 29.7%, and 42.8% (p < 0.001). There were no statistically significant differences in seizure freedom and seizure response rates by use of strong EiASMs. The rates of seizure freedom (20.0% vs. 16.6%; p = 0.341) and seizure response (39.7% vs. 26.9%; p = 0.006) were higher in patients receiving SCBs than those not receiving SCBs; 265 (25.8%) patients discontinued BRV. AEs were reported by 30.1% of patients, and were less common in patients treated with BRV and concomitant SCBs than those not treated with SCBs (28.9% vs. 39.8%; p = 0.017). Conclusion: The BRIVAFIRST provided real-world evidence on the effectiveness of BRV in patients with focal epilepsy irrespective of LEV history and concomitant ASMs, and suggested favourable therapeutic combinations

Riociguat treatment in patients with chronic thromboembolic pulmonary hypertension: Final safety data from the EXPERT registry

Objective: The soluble guanylate cyclase stimulator riociguat is approved for the treatment of adult patients with pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH) following Phase

An Intensity Index for Important Moments - A Mixed Method Biographical Analysis

An Intensity Index for Important Moments - A Mixed Method Biographical Analysis: Given the scale and complexity of data collected in large biographical qualitative surveys, the challenge is to develop the meaning that events take as seen by those who live them, without resorting to anecdotes. This paper proposes an articulation of qualitative and quantitative approaches based on intensity index of important moments (indice d’intensite´ des temps forts or IITF) that translates methodologically and statistically the event density variations that dot youth life course trajectories. An emergent categorization of important moments is presented and the association between areas of high event density and changes in the sphere of employment is examined using the IITF. A brief return to youth biographical narratives concerning these turbulent zones identified by index permits us to deepen understanding of these high intensity moments.Devant l’ampleur et la complexite´ des donne´es re´colte´es dans une vaste enqueˆte biographique qualitative, le de´fi consiste a` approfondir le sens que prennent les e´ve´nements aux yeux des acteurs sans avoir recours a` l’anecdote. Cet article propose une articulation des approches qualitatives et quantitatives qui repose sur un indice d’intensite´ des temps forts (IITF) permettant de traduire aux plans me´thodologique et statistique les variations de densite´ e´ve´nementielle qui e´maillent les parcours des jeunes. Une cate´gorisation e´mergente des temps forts est pre´sente´e et l’association entre les zones de forte densite´ e´ve´nementielle et les changements dans la sphe`re de l’emploi est examine´e a` l’aide de l’IITF. Un bref retour aux re´cits biographiques des jeunes autour de zones de turbulence cible´es par l’indice permet ensuite d’approfondir la compre´hension de ces moments de haute intensite´.Fil: Bourdon, Sylvain. University Of Sherbrooke; CanadáFil: Supeno, Eddy. University Of Sherbrooke; CanadáFil: Longo, Maria Eugenia. University Of Sherbrooke; CanadáFil: Deleo, Camila. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Saavedra 15. Centro de Estudios e Investigaciones Laborales; Argentin

Preparation and Characterization of Clay Nanocomposites of Plasticized Starch and Polypropylene Polymer Blends

Abstract Plasticized starch (PLS) is a renewable, degradable, and inexpensive polymer, but it suffers from poor mechanical properties. The mechanical properties can be improved by blending PLS with polyolefins, nonetheless, at high PLS content, the mechanical properties remain poor. Here we show that addition of clay can greatly improve the mechanical properties of PLS/polypropylene blends at high starch content. Unmodified and organically modified montmorillonite clays, MMT and Cloisite 30B respectively, were added to blends of glycerol-plasticized starch and polypropylene, compatibilized using maleated polypropylene. TEM indicates that MMT is well dispersed in the PLS phase of the blends, while Cloisite 30B is located both within the PLS phase as well as at the interface between PLS and PP. At high PLS content, the addition of clay increased the tensile strength and tensile modulus by an order of magnitude, while reducing the ultimate elongation only slightly. Such improvements are attributable to both the addition of clay as a reinforcing component, as well as to the change in the two phase morphology due to addition of clay