Efficacy and safety of antiepileptic drugs for refractory partial-onset epilepsy: a network meta-analysis
- 22 September 2017
- journal article
- review article
- Published by Springer Science and Business Media LLC in Zeitschrift für Neurologie
- Vol. 265 (1), 1-11
- https://doi.org/10.1007/s00415-017-8621-x
Abstract
The optimal combination of antiepileptic drugs (AEDs) for the treatment of refractory partial-onset epilepsy is a perpetual point of debate. While several network meta-analyses (NMAs) have been published, conclusions remain controversial, especially since newer AEDs have been introduced. In our review, we included the newer AEDs to evaluate the comparative efficacy and safety of AEDs for the treatment of refractory partial-onset epilepsy. We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials (Cochrane Library 2017, Issue 1) from their inception to February 18, 2017. The risk of bias in the included randomized controlled trials (RCTs) was evaluated according to the Cochrane Collaboration’s risk of bias tool. An NMA was performed with a Bayesian random-effects model, and we used the surface under the cumulative ranking curve to detect the optimal AEDs. Seventy-six RCTs with 17 AEDs and 20,711 patients were included in the NMAs, which showed that Brivaracetam (BRV), Levetiracetam (LEV), Oxcarbazepine (OXC), Topiramate, Vigabatrin (VGB), and Valproate (VPA) had a greater likelihood of allowing patients to achieve seizure freedom. We also found that LEV was associated with a lower withdrawal rate due to adverse effects than Lacosamide, Eslicarbazepine acetate, OXC, Pregabalin, and Retigabine. LEV, VGB, VPA, and BRV emerged as the agents with the best combination of properties when considering the efficacy and safety outcomes based on the full double-blind treatment period. However, it is critical to perform RCTs and to obtain prospective data from representative cohort studies.Funding Information
- Natural Science Foundation of Shandong Province of China (No.201611065160)
This publication has 31 references indexed in Scilit:
- Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysisThe Lancet, 2013
- Determinants of health-related quality of life in pharmacoresistant epilepsy: Results from a large multicenter study of consecutively enrolled patients using validated quantitative assessmentsEpilepsia, 2011
- Clinical comparability of the new antiepileptic drugs in refractory partial epilepsy: A systematic review and meta-analysisEpilepsia, 2011
- Anti‐convulsive and anti‐epileptic properties of brivaracetam (ucb 34714), a high‐affinity ligand for the synaptic vesicle protein, SV2ABritish Journal of Pharmacology, 2008
- SV2A protein is a broad-spectrum anticonvulsant target: Functional correlation between protein binding and seizure protection in models of both partial and generalized epilepsyNeuropharmacology, 2008
- Pharmacological Management of EpilepsyDrugs, 2008
- Combination of direct and indirect evidence in mixed treatment comparisonsStatistics in Medicine, 2004
- Patients with Refractory SeizuresThe New England Journal of Medicine, 1999
- Double‐Blind, Placebo‐Controlled Trial of Topiramate (600 mg Daily) for the Treatment of Refractory Partial EpilepsyEpilepsia, 1996
- Remission of epilepsy: results from the National General Practice Study of EpilepsyThe Lancet, 1995