PMID- 38449838
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240308
IS  - 2589-5370 (Electronic)
IS  - 2589-5370 (Linking)
VI  - 70
DP  - 2024 Apr
TI  - Efficacy, tolerability and safety of add-on third-generation antiseizure 
      medications in treating focal seizures worldwide: a network meta-analysis of 
      randomised, placebo-controlled trials.
PG  - 102513
LID - 10.1016/j.eclinm.2024.102513 [doi]
LID - 102513
AB  - BACKGROUND: Adjunctive newer antiseizure medications (ASMs) are being used in 
      patients with treatment-resistant focal-onset seizures (FOS). An updated network 
      meta-analysis (NMA) was necessary to compile evidence in this critical area. 
      METHODS: We systematically searched PubMed, Embase, Cochrane Library, Web of 
      Science, and Scopus from their inception until 17 January 2024, evaluating the 
      efficacy, tolerability, and safety of rufinamide (RUF), brivaracetam (BRV), 
      cenobamate (CNB), eslicarbazepine (ESL), lacosamide (LCM), retigabine (RTG), and 
      perampanel (PER) as adjunctive treatments for FOS. Efficacy outcomes included 
      seizure response and seizure freedom. Tolerability was assessed by 
      discontinuation due to adverse events (AEs). Safety outcomes were evaluated based 
      on the number of patients experiencing at least one AE and serious adverse events 
      (SAEs). This review is registered with PROSPERO (CRD42023485130). FINDINGS: A 
      total of 29 studies involving 11,750 participants were included. For seizure 
      response, all ASMs were significantly superior to placebo, with RTG ranking 
      highest, followed by CNB. Considering dosage, CNB 400 mg/d was top-ranked, 
      followed by RTG 1200 mg/d. For seizure freedom, BRV was highest-ranked, followed 
      by CNB, with BRV 100 mg/d leading, followed by CNB 400 mg/d. Regarding 
      tolerability, LCM 600 mg/d had the lowest ranking, followed by CNB 400 mg/d. For 
      the safety outcome of AEs, ESL 1200 mg/d was ranked lowest, followed by CNB 
      400 mg/d. Regarding SAEs, LCM 400 mg/d was ranked lowest, followed by RTG 
      1200 mg/d. INTERPRETATION: ASMs at different dosages have varying efficacy and 
      tolerability profiles. We have provided hierarchical rankings of ASMs for 
      efficacy and safety outcomes. Our findings offer the most comprehensive evidence 
      available to inform patients, families, physicians, guideline developers, and 
      policymakers about the choice of ASMs in patients with treatment-resistant FOS. 
      FUNDING: None.
CI  - (c) 2024 The Author(s).
FAU - Chen, Yankun
AU  - Chen Y
AD  - Department of Neurology, The Second Affiliated Hospital of Chongqing Medical 
      University, Chongqing, 400010, China.
FAU - Li, Wenze
AU  - Li W
AD  - Department of Neurology, The Second Affiliated Hospital of Chongqing Medical 
      University, Chongqing, 400010, China.
FAU - Lu, Chenfei
AU  - Lu C
AD  - Department of Respiratory, The Ninth People's Hospital of Chongqing, Chongqing, 
      400700, China.
FAU - Gao, Xinxia
AU  - Gao X
AD  - Department of Medical Records, Heze Municipal Hospital, Heze, 274000, China.
FAU - Song, Huizhen
AU  - Song H
AD  - Department of Neurology, Heze Third People's Hospital, Heze, 274000, China.
FAU - Zhang, Yanli
AU  - Zhang Y
AD  - Department of Neurology, Shandong Provincial Hospital Heze Branch, Heze, 274000, 
      China.
FAU - Zhao, Sihao
AU  - Zhao S
AD  - Department of Neurology, Heze Mudan District People's Hospital, Heze, 274000, 
      China.
FAU - Cai, Gaoang
AU  - Cai G
AD  - Department of Neurology, Juancheng County People's Hospital, Juancheng, 274600, 
      China.
FAU - Guo, Qing
AU  - Guo Q
AD  - Department of Neurology, Heze Municipal Hospital Brain Hospital, Heze, 274000, 
      China.
FAU - Zhou, Dongdong
AU  - Zhou D
AD  - Mental Health Center, University-Town Hospital of Chongqing Medical University, 
      Chongqing, 401331, China.
FAU - Chen, Yangmei
AU  - Chen Y
AD  - Department of Neurology, The Second Affiliated Hospital of Chongqing Medical 
      University, Chongqing, 400010, China.
LA  - eng
PT  - Journal Article
DEP - 20240228
PL  - England
TA  - EClinicalMedicine
JT  - EClinicalMedicine
JID - 101733727
PMC - PMC10915785
OTO - NOTNLM
OT  - Antiseizure medications
OT  - Epilepsy
OT  - Focal seizures
OT  - Network meta-analysis
OT  - Seizure
COIS- The authors report no conflicts of interest in this work.
EDAT- 2024/03/07 06:43
MHDA- 2024/03/07 06:44
PMCR- 2024/02/28
CRDT- 2024/03/07 04:10
PHST- 2023/12/03 00:00 [received]
PHST- 2024/02/13 00:00 [revised]
PHST- 2024/02/16 00:00 [accepted]
PHST- 2024/03/07 06:44 [medline]
PHST- 2024/03/07 06:43 [pubmed]
PHST- 2024/03/07 04:10 [entrez]
PHST- 2024/02/28 00:00 [pmc-release]
AID - S2589-5370(24)00092-0 [pii]
AID - 102513 [pii]
AID - 10.1016/j.eclinm.2024.102513 [doi]
PST - epublish
SO  - EClinicalMedicine. 2024 Feb 28;70:102513. doi: 10.1016/j.eclinm.2024.102513. 
      eCollection 2024 Apr.