Cenobamate for treatment-resistant focal seizures: current evidence and place in therapy

BACKGROUND: Cenobamate is newly approved for partial-onset seizures in adults, albeit the mechanism of its action remain poorly understood. METHODS: This article aims to review the efficacy, safety, and tolerability of cenobamate in treating partial-onset seizures. DATA COLLECTION: The English language articles were searched in the National Institute of Health clinical trials registry, PubMed, and the Cochrane library between 2010 and June 2021 using the keywords cenobamate, YKP 3089, and seizure, and filter “trial” was applied. RESULTS: A total of 31 articles were retrieved. Eventually, two randomized, double-blind, multicenter clinical trials involving 659 patients were analyzed. Cenobamate has shown significant reduction in seizure frequency compared to placebo. In cenobamate group, a greater number of participants showed ≥50% reduction in seizure frequency, adverse effects, and drug discontinuation compared to placebo. Multiple drug-drug interactions with other anti-seizure drugs were also observed. CONCLUSIONS: Based on the findings of these trials, cenobamate seems to be an attractive option for treatment-resistant partial-onset seizures; however, multiple treatment-related adverse effects and drug-drug interactions are the areas of concern.