Efficacy and safety of Fenfluramine hydrochloride for the treatment of seizures in Dravet syndrome: A real-world study.

Abstract

OBJECTIVE:

Dravet syndrome (DS) is a drug-resistant, infantile onset epilepsy syndrome with multiple seizure types and developmental delay. In recently published randomized controlled trials, fenfluramine (FFA) proved to be safe and effective in DS.

METHODS:

DS patients were treated with FFA in the Zogenix Early Access Program at four Italian pediatric epilepsy centers. FFA was administered as add-on, twice daily at an initial dose of 0.2 mg/kg/d up to 0.7 mg/kg/d. Seizures were recorded in a diary. Adverse events and cardiac safety (with Doppler echocardiography) were investigated every 3 to 6 months.

RESULTS:

Fifty-two patients were enrolled, with a median age of 8.6 years (interquartile range [IQR] = 4.1-13.9). Forty-five (86.5%) patients completed the efficacy analysis. The median follow-up was 9.0 months (IQR = 3.2-9.5). At last follow-up visit, there was a 77.4% median reduction in convulsive seizures. Thirty-two patients (71.1%) had a ≥50% reduction of convulsive seizures, 24 (53.3%) had a ≥75% reduction, and five (11.1%) were seizure-free. The most common adverse event was decreased appetite (n = 7, 13.4%). No echocardiographic signs of cardiac valvulopathy or pulmonary hypertension were observed. There was no correlation between type of genetic variants and response to FFA.

SIGNIFICANCE:

In this real-world study, FFA provided a clinically meaningful reduction in convulsive seizure frequency in the majority of patients with DS and was well tolerated.

• Authors: Nicola Specchio, Nicola Pietrafusa, Viola Doccini, Marina Trivisano, Francesca Darra, Francesca Ragona, Alberto Cossu, Silvia Spolverato, Domenica Battaglia, Michela Quintiliani, Maria Luigia Gambardella, Anna Rosati, Davide Mei, Tiziana Granata, Bernardo Dalla Bernardina, Federico Vigevano, Renzo Guerrini
• Journal: Epilepsia (Epilepsia) Vol. 61 Issue 11 Pg. 2405-2414 (11 2020) ISSN: 1528-1167 [Electronic] United States
• PMID: 32945537 (Publication Type: Journal Article, Multicenter Study, Pragmatic Clinical Trial)
• Copyright: © 2020 International League Against Epilepsy.

Chemical References

• Anticonvulsants
• Serotonin Uptake Inhibitors
• Fenfluramine

Topics

• Adolescent
• Adult
• Anorexia (chemically induced)
• Anticonvulsants (administration & dosage, adverse effects)
• Child
• Child, Preschool
• Epilepsies, Myoclonic (diagnostic imaging, drug therapy, physiopathology)
• Female
• Fenfluramine (administration & dosage, adverse effects)
• Follow-Up Studies
• Humans
• Male
• Prospective Studies
• Seizures (diagnostic imaging, drug therapy, physiopathology)
• Selective Serotonin Reuptake Inhibitors (administration & dosage, adverse effects)
• Treatment Outcome
• Young Adult