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Lamotrigine versus carbamazepine monotherapy for epilepsyGamble CL, Williamson PR, Marson AG
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SummaryLamotrigine versus carbamazepine monotherapy for epilepsyLamotrigine 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.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
January 25. 2006 AbstractBackgroundThe 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. ObjectivesTo 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 strategyWe 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 criteriaRandomized 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 analysisThis 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. Main resultsIndividual 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). Authors' conclusionsLamotrigine 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. |