Biohaven Reports New Clinical Data in Epilepsy with Opakalim, a Selective Kv7.2/7.3 Activator, Highlighting Seizure Control and Markedly Differentiated Tolerability Profile
- In a randomized, placebo-controlled, time-to-event trial in idiopathic generalized epilepsy (IGE), the median time to the second day with a generalized tonic-clonic seizure was 141 days in the opakalim 75 mg once-daily treatment group vs. 47 days in the placebo group, representing a 3-fold prolongation.
- In an ongoing open-label extension (OLE) study in focal epilepsy, an updated data analysis shows 54% of patients with focal epilepsy on opakalim 75 mg once-daily achieved a ≥50% reduction in seizure frequency over any consecutive six months of open-label treatment compared to pre-randomization baseline.
- A six-month update of opakalim compassionate use treatment in a Kv7-activation dependent patient with KCNQ2-Developmental and Epileptic Encephalopathy (KCNQ2-DEE) confirms clinical stability and ongoing seizure control. Overnight EEG at 6-months demonstrated a 50% reduction in seizure counts relative to pre-opakalim baseline.
- Opakalim has been well-tolerated across all studies (1000+ subjects to date) with a low incidence of adverse events (AEs) comparing favorably with approved and investigational antiseizure medicines.
- In the IGE study, the opakalim group reported no cases of somnolence, dizziness, fatigue, or memory impairment; and in the focal epilepsy OLE study, rates of these central nervous system (CNS) AEs were less than or equal to 5% each.
- Opakalim's tolerability profile is markedly differentiated from that of other investigational Kv7 activators reporting double-digit rates of CNS AEs in OLE studies.
- On track to receive top-line results in 2H 2026 from the first of two pivotal Phase 2/3 randomized, double-blind, placebo-controlled studies in refractory focal epilepsy to support registration.
The R&D Day presentation will showcase new and updated clinical data from: 1) a randomized, double-blind, placebo-controlled proof-of-concept study in idiopathic generalized epilepsy (IGE); 2) an ongoing focal epilepsy open-label extension (OLE) study; and 3) a six-month clinical update for a pediatric patient with KCNQ2 Developmental and Epileptic Encephalopathy (KCNQ2-DEE). Together, these emerging data reinforce opakalim's target engagement, differentiated profile and potential to address the unmet need for novel, effective, and well-tolerated ASMs.
Efficacy Signal in Highly Treatment-resistant IGE Population
Key Findings:
- Median time to second GTC seizure during the 24-week double-blind treatment period: 141 days on opakalim vs. 47 days on placebo, a 3-fold prolongation of time to second seizure event (Figure 1).
- 33% of opakalim-treated subjects completed the 24-week double-blind phase without a second GTC seizure vs. 0% of placebo subjects.
- 20% of opakalim-treated subjects completed the 24-week double-blind phase seizure-free vs. 0% of placebo subjects.
- Opakalim was well-tolerated with remarkably low rates of nervous system adverse events (AEs) including somnolence, dizziness, and fatigue — AEs that collectively occur in more than one-third of patients on competitor investigational Kv7 activator in long-term studies, and at even higher rates with approved ASMs.
Efficacy Signal and Differentiated Safety Profile in Focal Epilepsy OLE
Key Findings:
- In the opakalim 75 mg once-daily, six-month completers cohort (n>100), 54% of subjects achieved a ≥50% reduction in seizure frequency over any consecutive six months of OLE treatment compared to pretreatment baseline prior to randomization (Figure 2). This result is on par with the ≥50% responder rate reported for the investigational Kv7 activator azetukalner (56%), but opakalim achieves this comparable level of seizure control with a substantially lower burden of CNS AEs, including markedly lower rates of dizziness, somnolence, fatigue, and memory impairment.
- The AE profile was favorable and consistent with prior data, with a markedly lower incidence of AEs compared to approved and investigational ASMs (Figure 3). For example, in opakalim-treated subjects (75 mg), dizziness was reported in only 5.0% of subjects. By contrast, published long-term data from a competitor's Kv7 activator shows its open-label extension study reported dizziness in 25%, somnolence in 17%, memory impairment in 11%, and falls in 15% of subjects. These data suggest opakalim's selective Kv7.2/7.3 activation without GABA effects may translate into a meaningfully cleaner CNS tolerability profile than other ASMs.
Clinical Stability and Ongoing Seizure Control in Kv7-Dependent KCNQ2-DEE Patient
Key Finding:
- Now at the six-month mark, the patient remains clinically stable. Overnight EEG at six-months demonstrated a 50% reduction in seizure counts relative to pre-opakalim baseline. Opakalim has been well-tolerated over the six-month treatment period.
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