Background: Brivaracetam is a novel third-generation antiseizure medication and an analog of levetiracetam with selective affinity for synaptic vesicle protein 2A (SV2A). By binding SV2A, brivaracetam decreases pre-synaptic neurotransmitter release. Aim: We aimed to assess the safety and efficacy of brivaracetam in pediatric epilepsy. Method: We searched PubMed, Scopus, and Web of Science (WOS) for relevant clinical and observational studies from inception until February 2024. We carried out statistical analysis using Open Meta-Analyst. Dichotomous data were pooled as proportions with a 95% confidence interval (CI). Results: Eleven studies with a total of 805 patients were identified. The analysis of four studies revealed the more than 50% responder rate in a cohort of 252 focal epilepsy patients to be 51.5% (95% CI: [32.6%, 70.5%]). The analysis of three studies involving a cohort of 266 patients found a 20.7% incidence (95% CI: [15.8%, 25.6%]) of complete seizure freedom. The analysis of nine studies involving a cohort of 737 epilepsy patients revealed a retention rate of 66% (95% CI: [40%, 92%]). Conclusion: This study highlights the efficacy, tolerability, and safety of brivaracetam as adjunctive therapy in pediatric patients with epilepsy. The findings support its consideration as a valuable treatment option for children and adolescents, particularly those with drug-resistant epilepsy. Further trials with longer follow-up durations are needed to study the optimal doses and explore factors affecting drug response.

Background and Objective: Pregabalin (PGB) and duloxetine (DLX) are commonly used first-line medications in the clinical management of painful diabetic neuropathy (PDN), yet high-quality comparative evidence is limited. This meta-analysis evaluates the comparative efficacy and safety of PGB versus DLX, focusing on efficacy outcomes such as pain reduction and mental health, and safety outcomes including adverse events in PDN patients. Method: We searched electronic databases for relevant studies assessing the efficacy and safety of PGB and DLX in PDN. The primary outcomes were the mean change of the Visual Analog Scale (VAS) and the improvement ratio for patients achieving ≥ 50% pain reduction. Secondary outcomes include the Numeric Rating Scale (NRS) for pain, the Short Form 12 Health Survey (SF-12), and related adverse events. A random-effects meta-analysis was performed to evaluate these outcomes. Results: We analyzed 19 studies involving 4483 patients. PGB significantly reduced VAS scores at 24 weeks (MD = -0.38; 95% confidence interval [CI], -0.45 to -0.31; P < .0001) and decreased the mental component of SF-12 compared to DLX (MD = -3.36; 95% CI, -6.64 to -0.07; P = .05) and lower rates of achieving >50% pain reduction (risk ratio = 0.88; 95% CI, 0.79 to 0.98; P = .03). Regarding safety, PGB showed a lower incidence of several adverse events, including anorexia, decreased appetite, diarrhea, nausea, and vomiting. However, no significant differences in VAS scores were observed between PGB and DLX at 1 week, 2 weeks, 4 weeks, 6 weeks, 8 weeks, and 12 weeks, with similar results observed in NRS. Conclusion: We found that PGB and DLX showed similar efficacy in relieving PDN. Ultimately, the 2 drugs’ similar effectiveness and different safety profiles highlight the importance of considering patient-specific factors when choosing the appropriate treatment.

Migraine, a chronic neurological disorder, imposes a significant burden on individuals and healthcare systems globally. This systematic review and meta-analysis evaluated the efficacy and safety of atogepant in preventing episodic migraine (EM) in adults. A systematic search was conducted in four major databases (PubMed, Scopus, Web of Science, and Cochrane CENTRAL) up to June 2024. The inclusion criteria targeted randomized controlled trials (RCTs) comparing atogepant to placebo or standard care in patients with EM. Statistical analyses were performed using Review Manager (RevMan) software. Four RCTs with 2,018 patients receiving atogepant and 761 patients receiving placebo or standard care were included. Atogepant significantly reduced monthly migraine days compared to placebo at 10 mg daily (mean difference [MD], –1.16 days; 95% confidence interval [95% CI], –1.60 to –0.73), 30 mg daily (MD, –1.15 days; 95% CI, –1.64 to –0.66), 60 mg daily (MD, –1.48 days; 95% CI: –2.36 to –0.61 days), 30 mg twice daily (MD, –1.30 days; 95% CI, –2.17 to –0.43), and 60 mg twice daily (MD, –1.20 days; 95% CI, –1.90 to –0.50). A ≥50% reduction in migraine days was frequently significantly achieved with atogepant across all dosages. Atogepant was generally well tolerated, though it was associated with higher incidence rates of constipation and nausea compared to placebo. Atogepant is an effective and well-tolerated option for preventing EM, offering patients a noninvasive oral alternative to injectable therapies. Further research is warranted to explore its long-term safety and efficacy in diverse patient populations and refine its role in this field.