Network meta-analysis of antiepileptic drugs in focal drug-resistant epilepsy.
Epilepsy Res
; 167: 106433, 2020 11.
Article
en En
| MEDLINE
| ID: mdl-32866761
ABSTRACT
OBJECTIVE:
To compare and rank the efficacy and acceptability of new antiepileptic drugs (AEDs) for patients with focal drug-resistant epilepsy.METHODS:
PubMed, EMBASE, Cochrane databases and Clinicaltrials.gov were systematically searched from their inception through January 1, 2020, to identify trials evaluating AEDs for focal drug-resistant epilepsy. We included randomized controlled clinical trials (RCTs) comparing new AEDs with placebo or with other AEDs as adjunctive therapy for focal drug-resistant epilepsy. A Bayesian network meta-analysis was performed to determine efficacy and acceptability, as reflected by odds ratios (ORs), 95 % credible intervals (CrIs) with random-effects and consistent models.RESULTS:
Sixty-two RCTs were included, involving 12,739 patients with focal drug-resistant epilepsy. Regarding the seizure-free rate (40 RCTs involving 9,136 patients), 8 AEDs were more efficacious than placebo, with lnORs ranging between 1.69 for brivaracetam (95 % CrI, 0.56-2.81) and 0.72 for pregabalin (95 % CrI, 0.12-1.32). Regarding the responder rate, all AEDs except oxcarbazepine were more efficacious than placebo, with lnORs ranging between 1.31 for levetiracetam (95 % CrI, 0.92-1.71) and 0.66 for carisbamate (95 % CrI, 0.17-1.14). Regarding acceptability (60 RCTs comprising 12,139 patients), 9 AEDs were inferior to placebo. Estimated from seizure-free rate, brivaracetam was ranked as the most efficacious AED based on cumulative probability plots and SUCRAs, with fatigue as the main adverse event.CONCLUSION:
The results indicate that, based on seizure-free rate and all-cause discontinuation rate, brivaracetam is the most efficacious and acceptable AED, with mild adverse events and acknowledgement of potential publication bias.Palabras clave
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Pirrolidinonas
/
Quimioterapia Combinada
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Epilepsia Refractaria
/
Anticonvulsivantes
Tipo de estudio:
Clinical_trials
/
Systematic_reviews
Idioma:
En
Revista:
Epilepsy Res
Asunto de la revista:
CEREBRO
/
NEUROLOGIA
Año:
2020
Tipo del documento:
Article