Are the first-line Recommendations for Antiepileptic Drug Therapy Still Valid?  

Oleh:

Bazil, Carl

Jenis: Article from Bulletin/Magazine - ilmiah internasional
Dalam koleksi: Medical Progress vol. 34 no. 10 (Oct. 2007), page 473.

Ketersediaan

Perpustakaan FK Nomor Panggil: M36.K.2007.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

Background : To evaluate whether any of the four new-generation antiepileptic drugs (AEDs) shoul replace carbamazepin as first line therapy for partial seizure. Design : The standart and New Antiepileptic Drugs (SANAD) study was an unblinded, randomize, controlled trial conducted in the UK, and include patient with a history of two or more clinically definite inprovoked seizure in the previous year. Arm A, reported in the current paper, enrolled patient for wkom carbamazepine, rather than valproat, was deemed the better standart treatment by the recruiting physician. Between December 1999 and Agust 2004, 1,721 patients were randomly allocated to recieve carbamazepine (n=378), gabapentin (n=377), lamotrigine (n=378), oxcarbazepin (n=210), or topiramate (n=378). Attempts were made to follow up patients until at least May 2005 (some follow up data were obtained up to January 2006), with assessment at 3 months, 6 months and 1 year after randomization, and at 1 year intervals thereafter. Result : Lamotrigine was significantly better in terms of time to treatment failure than was carbamazepine (hazard ratio [HR] 0.78, 95% Cl 0.63 - 0.97), gabapentin (HR 0.65, 95% Cl 0.52-0.80), or topiramate (HR 0.64, 95% Cl 0.52-0.79); lamotrigine also tended to be superior oxcarbazepine (HR 0.87, 95% Cl 0.65-1.16). The reasons for treatment failure differed according to the drug taken : failure with carbamazepin or topiramate was most frequently associated with treatment withdrawal because of adverse events; failure with gabapentin was most frequently associated with withdrawal because of inadequate seizure control. For time to 1 year remission, carbamazepine achieved the best result (HR carbamazepin : gabapentin 0.75, 95% Cl 0.63-0.90), but the advantages of this agent relative to lamotrigine (HR 0.91, 95% Cl 0.77-1.09), topiramate (HR 0.86, 95% Cl 0.72-1.03) and oxcarbazepine (HR 0.92, 95% Cl 0.73-1.18) were not significant. In a per protocol analysis of time to 1-year remission, lamotrigine was inferior to carbamazepin at 1 year; however, no difference was observed at 2 years, and at 4 years lamotrigine was significantly better, indicating overall noninferiority of lamotrigine to carbamazepin for this outcome measure. Lamotrigine was more cost-effective than was carbamazepine in terms of both cost per seizure avoided and cost per quality-adjusted life year (QALY) gained. Conclution : Lamotrigine was clinically better and more cost-effective than was carbamazepin.

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