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Brivaracetam versus Levetiracetam for Epilepsy: A Review of Comparative Clinical Safety

Last updated: December 14, 2020
Project Number: RC1322-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report


  1. What is the clinical evidence regarding the comparative safety of brivaracetam versus levetiracetam in people with epilepsy with mental health conditions?
  2. What is the clinical evidence regarding the safety of switching from levetiracetam to brivaracetam in people with epilepsy with mental health symptoms related to levetiracetam?

Key Message

Ten nonrandomized studies were included in this report that provided low-to-moderate quality evidence regarding the safety of brivaracetam compared to levetiracetam in patients with epilepsy. Descriptive findings from one study found that in patients with epilepsy with psychiatric comorbidities, treatment with brivaracetam was associated with an improvement in psychiatric and behavioral adverse events such as aggression and depressive symptoms compared to that with levetiracetam. Due to the descriptive nature of results and methodological limitations of the study, the evidence was of low quality. In patients with epilepsy who had mental health symptoms related to treatment with levetiracetam, evidence from all included studies suggested that switching treatment to brivaracetam could improve the occurrences of such adverse events. Two studies found that significantly fewer patients reported behavioral symptoms during brivaracetam treatment compared to that during levetiracetam treatment. Among them one study was conducted in adult patients and the other study was conducted in children and adolescents. Descriptive results from seven other studies also found lower rates of occurrence of psychiatric or behavioral adverse events with brivaracetam than with previous levetiracetam treatment. Due to methodological limitations in the included studies (e.g., observational study design, concurrent treatment with other antiepileptic medications and subjective reporting of adverse events) the quality of evidence was low to moderate and findings should be interpreted with caution.