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.

Background/Objectives: Esaxerenone, a novel non-steroidal mineralocorticoid receptor antagonist, has shown promising results in the treatment of essential hypertension (HTN). This study aims to comprehensively analyze the effectiveness of esaxerenone to control BP in patients with essential HTN. Methods: A systematic search was performed on PubMed, Scopus, Web of Science (WOS), and Cochrane Library from inception until January 2025 for randomized controlled trials (RCTs) comparing esaxerenone with standard HTN usual care. The primary outcome of interest was mean changes in sitting systolic (SBP) and diastolic blood pressure (DBP). Other secondary outcomes were mean changes in 24 h-SBP and 24 h-DBP, and target BP achievement. Safety outcomes, such as adverse events and increased levels of potassium/uric acid, were also assessed. Results: Our meta-analysis included four studies with a total of 1981 patients, all conducted in Japan. Esaxerenone demonstrated dose-dependent blood pressure reductions. At 5 mg, sitting DBP decreased by 4.22 mmHg (95% CI −8.72 to 0.29; p = 0.07) and SBP by 9.07 mmHg (95% CI −17.69 to −0.45; p = 0.04), while the 1.25 mg dose showed smaller, non-significant reductions. For 24 h measurements, only the 5 mg dose achieved significant reductions. Target BP achievement increased by 48% overall (RR 1.48, 95% CI 1.11 to 1.96; p = 0.007), with stronger effects at 5 mg (RR 2.05, 95% CI 1.03 to 4.08; p = 0.04). Esaxerenone significantly reduced nocturnal SBP by 10.62 mmHg (95% CI −14.01 to −7.23; p < 0.001). Conclusions: In patients with essential HTN, esaxerenone was shown to be safe and well-tolerated compared with usual care. Long-term data on safety is warranted.

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