Intervention Review

Lamotrigine versus carbamazepine monotherapy for epilepsy

  1. Carrol L Gamble1,*,
  2. Paula R Williamson1,
  3. Anthony G Marson2

Editorial Group: Cochrane Epilepsy Group

Published Online: 25 JAN 2006

Assessed as up-to-date: 30 JUN 2007

DOI: 10.1002/14651858.CD001031.pub2


How to Cite

Gamble CL, Williamson PR, Marson AG. Lamotrigine versus carbamazepine monotherapy for epilepsy. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD001031. DOI: 10.1002/14651858.CD001031.pub2.

Author Information

  1. 1

    University of Liverpool, Centre for Medical Statistics and Health Evaluation, Liverpool, UK

  2. 2

    Clinical Sciences Centre for Research & Education, University Department of Neurological Science, Liverpool, Merseyside, UK

*Carrol L Gamble, Centre for Medical Statistics and Health Evaluation, University of Liverpool, Shelley's Cottage, Brownlow Street, Liverpool, L69 3GS, UK. c.gamble@liv.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 25 JAN 2006

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

The choice of an antiepileptic drug (AED) for any individual should take into account reliable information about seizure control, adverse effects and cost. Carbamazepine is the usual drug of choice for people with newly-diagnosed partial onset seizures. Lamotrigine is a relatively new AED which is licensed in many countries for use as an initial monotherapy.

Objectives

To review the best evidence comparing carbamazepine and lamotrigine when used as monotherapy in people with partial onset seizures, or generalized onset tonic-clonic seizures with or without other generalized seizure types.

Search methods

We searched the Cochrane Epilepsy Group's Specialized Register (July 2007), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2007), and MEDLINE (1966 to August 2007). No language restrictions were imposed. We also contacted pharmaceutical companies and trial investigators.

Selection criteria

Randomized controlled trials, blinded or unblinded, in which children or adults with partial onset seizures or generalized onset tonic-clonic seizures were randomized to monotherapy with either carbamazepine or lamotrigine.

Data collection and analysis

This was an individual patient data review. Outcomes were (1) time to treatment withdrawal, (2) time to first seizure post randomization, and (3) seizure freedom at six months.
Time to event data were analysed using a stratified logrank analysis with results expressed as hazard ratios (HR) and 95% confidence intervals (95% CI); binary data were expressed as relative risks (RR) and 95% confidence intervals (95% CI). A HR or a RR greater than 1 indicated an event was more likely on lamotrigine than carbamazepine.

Main results

Individual patient data were available for 1384 participants (100% of total randomized) from the five trials that met our inclusion criteria. The main results (HR (95% CI)) were (1) time to treatment withdrawal 0.55 (0.35 to 0.84) (random-effects), (2) time to first seizure post randomization 1.14 (95% CI 0.92 to 1.43), and (3) seizure freedom at six months RR 0.92 (95% CI 0.81 to 1.04).
The review suggested that time to treatment withdrawal was significantly improved with lamotrigine compared to carbamazepine, while time to first seizure and seizure freedom at six months favoured carbamazepine although the results were not statistically significant.

Authors' conclusions

Lamotrigine was significantly less likely to be withdrawn than carbamazepine but results for time to first seizure suggested that carbamazepine may be superior in terms of seizure control. Trials were of too short a duration to measure important seizure outcomes such as time to 12 month remission. Further trials are needed in which longer-term outcome is assessed as well as measures such as psychosocial outcome and quality of life.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Lamotrigine versus carbamazepine monotherapy for epilepsy

Lamotrigine has improved tolerability over carbamazepine but carbamazepine may be superior for seizure control.

The choice of an antiepileptic drug (AED) for any individual should take into account reliable information about seizure control, adverse effects and cost. Carbamazepine is the usual drug of choice for people with newly-diagnosed partial onset seizures. Lamotrigine is a relatively new AED which is licensed in many countries for use as an initial monotherapy. The review suggested that time to treatment withdrawal was significantly improved with lamotrigine compared to carbamazepine, while time to first seizure and seizure freedom at six months favoured carbamazepine although the results were not statistically significant.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

以Lamotrigine或Carbamazepine作為癲癇的單一藥物治療之比較

當選擇抗癲癇藥物(antiepileptic drug ,AED)治療患者時,應考慮有關癲癇發作控制,藥物不良反應和成本的可靠資訊。Carbamazepine是新診斷出有局部型癲癇發作的患者常用的藥物。Lamotrigine是相對較新的一種抗癲癇藥物,得到許多國家的批准使用在初步的單一藥物治療。

目標

這裏回顧了比較Carbamazepine和Lamotrigine作為單一藥物治療局部型癲癇發作或全盤型強直陣攣發作(不論有無合併其他全盤型癲癇發作類型)的最佳證據,。

搜尋策略

我們搜尋了Cochrane Epilepsy Group's Specialized Registe(2005年7月)以及Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library,2005年第2期), MEDLINE (1966 年2005年8月)。沒有設定任何語言限制。 我們也聯繫了製藥公司和參與臨床試驗的研究人員。

選擇標準

選擇對患有局部型癲癇發作或全盤型強直強直陣攣發作的兒童或成年人進行的隨機對照試驗(不論有無遮盲),而該試驗必須將受試者隨機分配到使用Carbamazepine或Lamotrigine的單一藥物治療組別。

資料收集與分析

本研究是取自臨床試驗中個別病患資料的回顧。治療成果的收集包括 (1) 開始治療後至停止試驗用藥時間,(2) 開始隨機分配治療後至首次癲癇發作的時間,(3) 開始治療後的第6個月達成癲癇無發作。我們使用stratified logrank analysis來分析達成事件所需時間的資料,將結果呈現為hazard ratios (HR) 和95% confidence intervals (95% CI);而將二元資料 (binary data) 呈現為relative risks (RR) 和 95% confidence intervals (95% CI)。其中HR>1或 RR>1 表示該事件發生在Lamotrigine的可能性大於Carbamazepine。

主要結論

我們從5個符合選擇標準的試驗中取得其中1384位受試者的相關資料,100% 都是經由隨機分配的。 主要治療成果的HR (95% CI) 如下:(1) 開始治療後至停止試驗用藥時間為0.55 (0.35 – 0.84) (隨機效果),(2) 開始隨機分配治療後至首次癲癇發作的時間為1.14 (95% CI 0.92 – 1.43),(3) 開始治療後的第6個月達成癲癇無發作的RR 為0.92 (95% CI 0.81 – 1.04)。本回顧顯示Lamotrigine比Carbamazepine更能有效改善開始治療後至停止試驗用藥的時間;然而儘管結果未達到統計上的顯著意義,Carbamazepine可能較有利於開始治療後至首次癲癇發作的時間以及於第6個月達成癲癇無發作等兩方面。

作者結論

Lamotrigine比Carbamazepine明顯不會被中斷停止治療,但是從開始治療後至首次癲癇發作的時間的結果來看,Carbamazepine在癲癇發作控制方面可能具有較強優勢。但由於試驗期間太短,無法評估一些重要的治療成果,例如,開始治療後至達成連續12個月緩解的時間。我們需要更多的臨床試驗來評估長期治療以及心理社會和生活品質等成果。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

Lamotrigine比Carbamazepine更能提高耐受性,但是Carbamazepine在癲癇發作控制方面可能具有較強優勢。當選擇抗癲癇藥物 (AED) 治療患者時,應考慮有關癲癇發作控制,藥物不良反應和成本的可靠資訊。Carbamazepine是新診斷出有局部型癲癇發作患者的首選藥物。Lamotrigine是相對較新的AED,得到許多國家的批准在初步的單一藥物治療中使用。本回顧指出Lamotrigine比Carbamazepine更能改善開始治療後至停止試驗用藥的時間;然而儘管結果未達到統計上的顯著意義,Carbamazepine可能較有利於開始治療後至首次癲癇發作的時間以及於第6個月達成癲癇無發作等兩方面。