PMID- 29784458
OWN - NLM
STAT- MEDLINE
DCOM- 20190326
LR  - 20190326
IS  - 1872-6844 (Electronic)
IS  - 0920-1211 (Linking)
VI  - 143
DP  - 2018 Jul
TI  - Efficacy of antiepileptic drugs in the adjunctive treatment of refractory 
      partial-onset seizures: Meta-analysis of pivotal trials.
PG  - 120-129
LID - S0920-1211(17)30176-6 [pii]
LID - 10.1016/j.eplepsyres.2017.10.004 [doi]
AB  - OBJECTIVE: In the absence of randomized clinical trials (RCTs) assessing the 
      relative efficacy of antiepileptic drugs (AEDs), meta-analyses are useful 
      resources for informing treatment choices. This meta-analysis assesses the 
      relative efficacy and tolerability of AEDs for adjunctive treatment of refractory 
      partial onset seizures (POS). METHODS: A systematic literature review was 
      conducted to identify pivotal AED trials serving as the basis for US Food and 
      Drug Administration (FDA) approval. INCLUSION CRITERIA: 1) double-blind, 
      placebo-controlled, parallel-group design, with 8- to 14-week maintenance period; 
      2) enrolled patients >/=16years with refractory POS, including complex partial 
      seizures; 3) study was conducted between 1993 and 2013; and; 4) patients received 
      FDA-approved dosage. Outcomes analyzed: 1) 50% responder rate (>/=50% reduction 
      from baseline in seizure frequency); 2) seizure freedom (proportion of 
      seizure-free patients); and 3) discontinuation due to adverse events (AEs). 
      DerSimonian and Laird random-effects model was used to derive odds ratios (OR) 
      and 95% confidence intervals (CI). RESULTS: A total of 29 publications for 11 
      AEDs (eslicarbazepine, ezogabine, gabapentin, lacosamide, levetiracetam, 
      perampanel, pregabalin, tiagabine, topiramate, vigabatrin, and zonisamide) were 
      included in the meta-analysis. Tiagabine 56mg/day (OR 8.82, 95% CI: 2.77-28.11), 
      pregabalin 600mg/day (OR 8.08, 95% CI: 5.45-11.98), and vigabatrin 3000mg/day (OR 
      6.23, 95% CI: 1.46-26.20) had the highest OR versus placebo of 50% response. The 
      odds of seizure freedom were >/=7 times greater than placebo for levetiracetam 
      3000mg/day (OR 11.00, 95% CI: 2.08-58.06), vigabatrin 3000mg/day (OR 7.41, 95% 
      CI: 1.31-41.84), and ezogabine 1200mg/day (OR 7.09, 95% CI: 0.36-58.06). Patients 
      were more likely to discontinue any AED (except low-dose pregabalin) than 
      placebo. CONCLUSION: In this meta-analysis of >9000 patients, those treated with 
      AEDs were more likely than placebo to achieve seizure response or freedom. 
      Patients receiving pregabalin, tiagabine, and vigabatrin had the highest odds of 
      >/=50% reduction in seizures, and patients receiving ezogabine, levetiracetam, and 
      vigabatrin had the highest odds of seizure freedom.
CI  - Copyright (c) 2017 The Authors. Published by Elsevier B.V. All rights reserved.
FAU - Slater, Jeremy
AU  - Slater J
AD  - University of Texas Health Science Center at Houston, Houston, TX, USA. 
      Electronic address: Jeremy.D.Slater@uth.tmc.edu.
FAU - Chung, Steve
AU  - Chung S
AD  - Banner University Medical Center, Phoenix, AZ, USA.
FAU - Huynh, Lynn
AU  - Huynh L
AD  - Analysis Group, Inc, Boston, MA, USA.
FAU - Duh, Mei Sheng
AU  - Duh MS
AD  - Analysis Group, Inc, Boston, MA, USA.
FAU - Gorin, Brian
AU  - Gorin B
AD  - Analysis Group, Inc, Boston, MA, USA.
FAU - McMicken, Carolyn
AU  - McMicken C
AD  - Lundbeck LLC, Deerfield, IL, USA.
FAU - Ziemann, Adam
AU  - Ziemann A
AD  - Lundbeck LLC, Deerfield, IL, USA.
FAU - Isojarvi, Jouko
AU  - Isojarvi J
AD  - Lundbeck LLC, Deerfield, IL, USA.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
PL  - Netherlands
TA  - Epilepsy Res
JT  - Epilepsy research
JID - 8703089
RN  - 0 (Anticonvulsants)
SB  - IM
MH  - Anticonvulsants/*therapeutic use
MH  - Chemotherapy, Adjuvant
MH  - Drug Resistance
MH  - Drug Resistant Epilepsy/drug therapy
MH  - Epilepsies, Partial/drug therapy
MH  - Humans
MH  - Seizures/*drug therapy
OTO - NOTNLM
OT  - AEDs
OT  - Antiepileptic drugs
OT  - Meta-analysis
OT  - Refractory partial-onset seizures
OT  - rPOS
EDAT- 2018/05/23 06:00
MHDA- 2019/03/27 06:00
CRDT- 2018/05/23 06:00
PHST- 2017/03/24 00:00 [received]
PHST- 2017/07/14 00:00 [revised]
PHST- 2017/10/03 00:00 [accepted]
PHST- 2018/05/23 06:00 [entrez]
PHST- 2018/05/23 06:00 [pubmed]
PHST- 2019/03/27 06:00 [medline]
AID - S0920-1211(17)30176-6 [pii]
AID - 10.1016/j.eplepsyres.2017.10.004 [doi]
PST - ppublish
SO  - Epilepsy Res. 2018 Jul;143:120-129. doi: 10.1016/j.eplepsyres.2017.10.004.