Lamotrigine versus carbamazepine monotherapy for epilepsy

The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial

“…Other studies have compared lamotrigine with carbamazepine in similar populations, though over much shorter periods, and a meta-analysis of individual patient data has been undertaken 26. This meta-analysis showed that lamotrigine was better tolerated, and less likely to be associated with treatment failure, in agreement with our results.…”

The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial

“…Other studies have compared lamotrigine with carbamazepine in similar populations, though over much shorter periods, and a meta-analysis of individual patient data has been undertaken 26. This meta-analysis showed that lamotrigine was better tolerated, and less likely to be associated with treatment failure, in agreement with our results.…”

Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes

“…Since the last report, a total of six RCTs (Steinhoff et al., ; Brodie et al., ; Marson et al., ; Ramsay et al., ; Kwan et al., ; Baulac et al., ) and four new meta‐analyses (Gamble et al., ,b; Muller et al., ; Koch & Polman, ) examined the efficacy/effectiveness of initial monotherapy of adults with partial‐onset seizures. Among the six RCTs, two were considered class I studies (Brodie et al., ; Baulac et al., ), whereas the other four met criteria for class III studies because of an open‐label design (Steinhoff et al., ; Marson et al., ), too brief treatment duration (Steinhoff et al., ; Ramsay et al., ), or lack of an adequate comparator (Kwan et al., ).…”

“…Four recent meta‐analyses examined AED efficacy and effectiveness for adults with partial‐onset seizures (Gamble et al., ,b; Muller et al., ; Koch & Polman, ). Two of these meta‐analyses examined LTG versus CBZ (Gamble et al., ,b), whereas the others focused on OXC versus PHT (Muller et al., ) and OXC versus CBZ (Koch & Polman, ). The meta‐analyses had similar end points: time to withdrawal, number of patients achieving 6 or months or more seizure freedom, and time to first seizure.…”

“…Most data used in these meta‐analyses were from class III studies. The meta‐analyses found that “OXC is significantly better than PHT for time to treatment withdrawal, but suggest no overall difference between OXC and PHT for other outcomes” (Muller et al., ), “OXC and CBZ appear to be similarly effective and well tolerated” with “no overall difference in time to treatment withdrawal” between them (Koch & Polman, ), and that “LTG is significantly less likely to be withdrawn than CBZ, but results for time to first seizure suggest a nonsignificant trend that CBZ may be superior in terms of seizure control” (Gamble et al., ,b). The authors identify significant methodologic flaws in the underlying clinical trials that limit the direct applicability of the results to clinical practice.…”

“…Since the last review, two RCTs (Sobaniec et al., ; Eun et al., ) and four new meta‐analyses (Gamble et al., ,b; Muller et al., ; Koch & Polman, ) examined initial monotherapy of children with partial‐onset seizures. Both RCTs were considered class III studies because of an open‐label design, too short treatment duration (Sobaniec et al., ; Eun et al., ), and a forced exit criteria (Sobaniec et al., ).…”

The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial

“…Other studies have compared lamotrigine with carbamazepine in similar populations, though over much shorter periods, and a meta-analysis of individual patient data has been undertaken 26. This meta-analysis showed that lamotrigine was better tolerated, and less likely to be associated with treatment failure, in agreement with our results.…”

Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes

“…Since the last report, a total of six RCTs (Steinhoff et al., ; Brodie et al., ; Marson et al., ; Ramsay et al., ; Kwan et al., ; Baulac et al., ) and four new meta‐analyses (Gamble et al., ,b; Muller et al., ; Koch & Polman, ) examined the efficacy/effectiveness of initial monotherapy of adults with partial‐onset seizures. Among the six RCTs, two were considered class I studies (Brodie et al., ; Baulac et al., ), whereas the other four met criteria for class III studies because of an open‐label design (Steinhoff et al., ; Marson et al., ), too brief treatment duration (Steinhoff et al., ; Ramsay et al., ), or lack of an adequate comparator (Kwan et al., ).…”

“…Four recent meta‐analyses examined AED efficacy and effectiveness for adults with partial‐onset seizures (Gamble et al., ,b; Muller et al., ; Koch & Polman, ). Two of these meta‐analyses examined LTG versus CBZ (Gamble et al., ,b), whereas the others focused on OXC versus PHT (Muller et al., ) and OXC versus CBZ (Koch & Polman, ). The meta‐analyses had similar end points: time to withdrawal, number of patients achieving 6 or months or more seizure freedom, and time to first seizure.…”

“…Most data used in these meta‐analyses were from class III studies. The meta‐analyses found that “OXC is significantly better than PHT for time to treatment withdrawal, but suggest no overall difference between OXC and PHT for other outcomes” (Muller et al., ), “OXC and CBZ appear to be similarly effective and well tolerated” with “no overall difference in time to treatment withdrawal” between them (Koch & Polman, ), and that “LTG is significantly less likely to be withdrawn than CBZ, but results for time to first seizure suggest a nonsignificant trend that CBZ may be superior in terms of seizure control” (Gamble et al., ,b). The authors identify significant methodologic flaws in the underlying clinical trials that limit the direct applicability of the results to clinical practice.…”

“…Since the last review, two RCTs (Sobaniec et al., ; Eun et al., ) and four new meta‐analyses (Gamble et al., ,b; Muller et al., ; Koch & Polman, ) examined initial monotherapy of children with partial‐onset seizures. Both RCTs were considered class III studies because of an open‐label design, too short treatment duration (Sobaniec et al., ; Eun et al., ), and a forced exit criteria (Sobaniec et al., ).…”

The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial

“…Other studies have compared lamotrigine with carbamazepine in similar populations, though over much shorter periods, and a meta-analysis of individual patient data has been undertaken 26. This meta-analysis showed that lamotrigine was better tolerated, and less likely to be associated with treatment failure, in agreement with our results.…”

Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes

“…Since the last report, a total of six RCTs (Steinhoff et al., ; Brodie et al., ; Marson et al., ; Ramsay et al., ; Kwan et al., ; Baulac et al., ) and four new meta‐analyses (Gamble et al., ,b; Muller et al., ; Koch & Polman, ) examined the efficacy/effectiveness of initial monotherapy of adults with partial‐onset seizures. Among the six RCTs, two were considered class I studies (Brodie et al., ; Baulac et al., ), whereas the other four met criteria for class III studies because of an open‐label design (Steinhoff et al., ; Marson et al., ), too brief treatment duration (Steinhoff et al., ; Ramsay et al., ), or lack of an adequate comparator (Kwan et al., ).…”

“…Four recent meta‐analyses examined AED efficacy and effectiveness for adults with partial‐onset seizures (Gamble et al., ,b; Muller et al., ; Koch & Polman, ). Two of these meta‐analyses examined LTG versus CBZ (Gamble et al., ,b), whereas the others focused on OXC versus PHT (Muller et al., ) and OXC versus CBZ (Koch & Polman, ). The meta‐analyses had similar end points: time to withdrawal, number of patients achieving 6 or months or more seizure freedom, and time to first seizure.…”

“…Most data used in these meta‐analyses were from class III studies. The meta‐analyses found that “OXC is significantly better than PHT for time to treatment withdrawal, but suggest no overall difference between OXC and PHT for other outcomes” (Muller et al., ), “OXC and CBZ appear to be similarly effective and well tolerated” with “no overall difference in time to treatment withdrawal” between them (Koch & Polman, ), and that “LTG is significantly less likely to be withdrawn than CBZ, but results for time to first seizure suggest a nonsignificant trend that CBZ may be superior in terms of seizure control” (Gamble et al., ,b). The authors identify significant methodologic flaws in the underlying clinical trials that limit the direct applicability of the results to clinical practice.…”

“…Since the last review, two RCTs (Sobaniec et al., ; Eun et al., ) and four new meta‐analyses (Gamble et al., ,b; Muller et al., ; Koch & Polman, ) examined initial monotherapy of children with partial‐onset seizures. Both RCTs were considered class III studies because of an open‐label design, too short treatment duration (Sobaniec et al., ; Eun et al., ), and a forced exit criteria (Sobaniec et al., ).…”