{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T06:49:02Z","timestamp":1780555742072,"version":"3.54.1"},"reference-count":16,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T00:00:00Z","timestamp":1620864000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia Open"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Need for rescue therapy differs among patients with seizure clusters. Diazepam nasal spray is approved to treat seizure clusters in patients with epilepsy \u22656\u00a0years of age. This analysis used interim data from a phase 3 safety study to assess safety profile and effectiveness of diazepam nasal spray using average number of doses\/month as a proxy measurement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This phase 3, open\u2010label, repeat\u2010dose, safety study of diazepam nasal spray enrolled patients (6\u201065\u00a0years) with epilepsy and need of benzodiazepine rescue. Patients were stratified by average number of doses\/month (&lt;2, moderate frequency; 2\u20105, high frequency; &gt;5, very\u2010high frequency). Safety was evaluated based on treatment\u2010emergent adverse events (TEAEs), assessed nasal irritation, and olfaction. The proportion of treatments given as a second dose was used as an exploratory proxy for effectiveness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 175 enrolled patients (data cutoff, October 31, 2019), 158 received \u22651 dose of diazepam nasal spray. Frequency of use was moderate in 43.7% of patients, high in 50.6% of patients, and very high in 5.7% of patients. Patients treated 3397 seizure episodes (moderate frequency, 14.2%; high frequency, 59.9%; very high frequency, 25.8%). Nasal discomfort was the most common treatment\u2010related TEAE in all groups. No notable changes in nasal irritation or olfaction were observed. Second doses represented only 2.5%, 7.5%, and 17.2% of all doses in the moderate\u2010, high\u2010, and very\u2010high\u2010frequency groups, respectively. Overall retention rate was 82.9%, without an observed relationship to frequency of use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>Frequency of dosing diazepam nasal spray had little impact on the safety\/tolerability profile across a range of &lt;2 to &gt;5 doses\/month. Effectiveness was suggested for all dosing frequencies by the high proportion of seizure clusters not treated with a second dose. These results support the utility, safety profile, and effectiveness of diazepam nasal spray across frequencies of seizure cluster burden.<\/jats:p><\/jats:sec>","DOI":"10.1002\/epi4.12494","type":"journal-article","created":{"date-parts":[[2021,5,5]],"date-time":"2021-05-05T10:21:48Z","timestamp":1620210108000},"page":"504-512","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Consistent safety and tolerability of Valtoco<sup>\u00ae<\/sup> (diazepam nasal spray) in relationship to usage frequency in patients with seizure clusters: Interim results from a phase 3, long\u2010term, open\u2010label, repeat\u2010dose safety study"],"prefix":"10.1002","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0416-1015","authenticated-orcid":false,"given":"Ian","family":"Miller","sequence":"first","affiliation":[{"name":"Formerly Nicklaus Children's Hospital Miami FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James W.","family":"Wheless","sequence":"additional","affiliation":[{"name":"Le Bonheur Children's Hospital University of Tennessee Health Science Center Memphis TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2272-5005","authenticated-orcid":false,"given":"Robert E.","family":"Hogan","sequence":"additional","affiliation":[{"name":"Washington University in St. Louis St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis","family":"Dlugos","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Biton","sequence":"additional","affiliation":[{"name":"Arkansas Epilepsy Program Little Rock AR USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory D.","family":"Cascino","sequence":"additional","affiliation":[{"name":"Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0708-6006","authenticated-orcid":false,"given":"Michael R.","family":"Sperling","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kore","family":"Liow","sequence":"additional","affiliation":[{"name":"Hawaii Pacific Neuroscience Honolulu HI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blanca","family":"Vazquez","sequence":"additional","affiliation":[{"name":"Comprehensive Epilepsy Center New York University New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric B.","family":"Segal","sequence":"additional","affiliation":[{"name":"Hackensack University Medical Center and Northeast Regional Epilepsy Group Hackensack NJ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Tarquinio","sequence":"additional","affiliation":[{"name":"Center for Rare Neurological Diseases Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weldon","family":"Mauney","sequence":"additional","affiliation":[{"name":"Northwest Florida Clinical Research Group Gulf Breeze FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Desai","sequence":"additional","affiliation":[{"name":"Children's Hospital of Los Angeles Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian L.","family":"Rabinowicz","sequence":"additional","affiliation":[{"name":"Neurelis, Inc. 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