William Rosenfeld, MD

“What I found very interesting was that the numbers were even better than expected; the fact that we saw such high numbers for the seizure freedom. The double blind was where there was 20% [seizure freedom], but we're seeing numbers that are better [in the open-label], numbers from 25 to 33%, seizure freedom numbers.”

William Rosenfeld, MD, neurologist, Comprehensive Epilepsy Care Center and colleagues presented data from a post-hoc analysis of a 

American Epilepsy Society (AES) Annual Meeting, December 4–8, 2020

 that suggested that reducing doses of concomitant anti-seizure medications (ASMs) led to fewer patients with focal seizures discontinuing cenobamate (Xcopri; SK Life Science). Cenobamate was approved for the treatment of partial-onset seizures in late 2019.

Rosenfeld and colleagues found that among patients who remained on cenobamate, 91 of the 401 (22.7%) concomitant baseline ASM doses were discontinued completely. Most patients had significant reductions in seizure frequency across focal seizure types. When comparing total baseline seizure frequency to last 3-month visit, 85% of patients had ≥50% reduction, 74% had ≥75% reduction, and 57.2% had 100% reduction in seizures.

 spoke with Rosenfeld to learn more about the efficacy of cenobamate in achieving seizure freedom. He also discussed future plans to investigate cenobamate in pediatric studies, for primary generalized tonic clonic seizures, and eventually as a monotherapy.

Rosenfeld W, Aboumatar S, Bhatia P, et al. Dose adjustments to concomitant antiseizure medications: post-hoc analysis of a phase 3, open-label study of cenobamate for the treatment of uncontrolled focal seizures. Presented at AES 2020 Annual Meeting; December 4–8, 2020. Abstract 336.

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The neurologist from the Comprehensive Epilepsy Care Center for Children and Adults, in St. Louis, Missouri, also discussed future studies planned for cenobamate. 

Future Studies on Cenobamate for Epilepsy: William Rosenfeld, MD

"The key part was that cenobamate appeared to work with whichever antiseizure medication (ASM) the patient was on.... it's the efficacy of cenobamate, the retention, the seizure freedom numbers, and the ability to reduce ASMS that speaks about to the success of cenobamate.”

Cenobamate (Xcopri; SK Life Science) was approved for the treatment of partial-onset seizures in late 2019. Data from a post-hoc analysis of a phase 3 study presented at the 

 suggested that reducing doses of concomitant ASMs led to fewer patients with focal seizures discontinuing cenobamate.

Presenter William Rosenfeld, MD, neurologist, Comprehensive Epilepsy Care Center and colleagues found that among patients who remained on cenobamate, 91 of the 401 (22.7%) concomitant baseline ASM doses were discontinued completely. Carbamazepine accounted for 28.6% of patients, oxycarbazepine for 25%, lacosamide for 21.5%, eslicarbazepine for 23.1%, clobazam for 22.6%, lamotrigine for 15.4%, and levetiracetam for 14.1%.

 spoke with Rosenfeld to learn more about the concomitant ASMs that were used with cenobamate and how different levels of intractable patients found efficacy with cenobamate. He also discussed how the open-label study was valuable in being able to adjust dosages.

The neurologist from the Comprehensive Epilepsy Care Center for Children and Adults, in St. Louis, Missouri, discussed the different medications that cenobamate was used with. 

William Rosenfeld, MD: Reducing Concomitant ASM Dosages for Focal Seizures

“[Cenobamate]… had some very excellent efficacy. I think our whole paradigm might be shifting because of the numbers that we were seeing in terms of seizure freedom.”

A post-hoc analysis of a phase 3 study investigating cenobamate (Xcopri; SK Life Science) presented at the 

American Epilepsy Society (AES) Annual Meeting

, December 4–8, 2020 found that fewer patients with focal seizures discontinued cenobamate after reducing doses of concomitant antiseizure medications (ASMs). The medication was approved for the treatment of partial-onset seizures in late 2019.

Among the investigators is William Rosenfeld, MD, neurologist, Comprehensive Epilepsy Care Center for Children and Adults, in St. Louis, Missouri. Rosenfeld and colleagues found that patients that decreased their mean concomitant ASM use were more likely to continue using cenobamate as compared to patients that did not decrease mean concomitant ASM use. These decreases were mostly due to adverse events (AEs) that appeared early in the study during titration or early maintenance phases when cenobamate doses were escalated.

 spoke with Rosenfeld to learn more about cenobamate and the sizable decrease in concomitant ASM use that his team saw. He discussed the value in a medication that shows efficacy in refractory epilepsy and that can potentially cut down the amount of ASMs patients use.

The neurologist from the Comprehensive Epilepsy Care Center for Children and Adults, in St. Louis, Missouri, discussed how his team saw a roughly 25% decrease in the mean use of concomitant ASMs. 

William Rosenfeld, MD: Decreasing Concomitant ASM Use With Cenobamate for Epilepsy

“We were able to lower the concomitant medications and maintain the efficacy of cenobamate, and that efficacy was quite good.”

Data from a post-hoc analysis of a phase 3 study suggest that reducing doses of concomitant antiseizure medications (ASMs) led to fewer patients with focal seizures discontinuing cenobamate (Xcopri; SK Life Science). These data were presented at the 

, December 4–8, 2020. The SK Life Science product was approved in late 2019 for the treatment of partial-onset seizures.

William Rosenfeld, MD, neurologist, Comprehensive Epilepsy Care Center for Children and Adults, in St. Louis, Missouri, and colleagues found that patients were more likely to continue using cenobamate when they decreased their mean concomitant ASM use as compared to patients that did not decrease mean concomitant ASM use. These decreases were mostly due to adverse events (AEs) that appeared early in the study during titration or early maintenance phases when cenobamate doses were escalated.

 spoke with Rosenfeld to learn more about cenobamate and how the early appearance of adverse events allowed for the team to analyze long-term data on the changing doses of concomitant ASMs. He stated that with further study, researchers will be able to further identify the most efficacious and AE-free combinations of ASMs.

The neurologist from the Comprehensive Epilepsy Care Center for Children and Adults, in St. Louis, Missouri, discussed how his team succeeded at titrating cenobamate early in the study. 

William Rosenfeld, MD

Articles

Future Studies on Cenobamate for Epilepsy: William Rosenfeld, MD

William Rosenfeld, MD: Reducing Concomitant ASM Dosages for Focal Seizures

William Rosenfeld, MD: Decreasing Concomitant ASM Use With Cenobamate for Epilepsy

William Rosenfeld, MD: Finding Ideal Combinations of Cenobamate and Concurrent ASMs