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Carbamazepine versus phenytoin monotherapy for epilepsyTudur Smith C, Marson AG, Clough HE, Williamson PR
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SummaryCarbamazepine versus phenytoin monotherapy for epilepsyThere is no evidence to suggest any difference between the drugs carbamazepine and phenytoin for the seizure types studied. Epilepsy is a disorder where recurrent seizures are caused by abnormal electrical discharges from the brain. Carbamazepine and phenytoin are considered first line treatments in many countries both for partial onset seizures and generalized tonic-clonic seizures. The review of trials found no difference between carbamazepine and phenytoin for the control of the seizure types studied.
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:
April 22. 2002 AbstractBackgroundWorldwide, carbamazepine and phenytoin are commonly used antiepileptic drugs. This review summarizes evidence from randomized controlled trials in which these two drugs have been compared. ObjectivesTo review the best evidence comparing carbamazepine and phenytoin 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 3, 2007), and MEDLINE (1966 to July 2007). No language restrictions were imposed. We also contacted pharmaceutical companies, experts in the field, and trial investigators. Selection criteriaRandomized controlled trials in children or adults with partial onset seizures or generalized onset tonic-clonic seizures. Trials must have included a comparison of carbamazepine monotherapy with phenytoin monotherapy. Data collection and analysisThis was an individual patient data review. Outcomes were time to (a) withdrawal of allocated treatment; (b) 12 month remission; (c) six month remission and (d) first seizure post randomization. Data were analysed using a stratified logrank analysis with results expressed as hazard ratios (HR) and 95% confidence intervals (95% CI), where a HR greater than one indicates an event is more likely on phenytoin. Main resultsIndividual patient data are available for 551 participants from three trials, representing 61% of the participants recruited into the nine trials that met our inclusion criteria. By convention, for the outcomes time to six and 12 month remission HR greater than one indicates a clinical advantage for phenytoin, whilst for time to withdrawal and first seizure HR greater than one indicates a clinical advantage for carbamazepine. Results (HRs) were: (i) time to withdrawal of allocated treatment 0.97 (95% CI 0.74 to 1.28); (ii) time to 12 month remission 1.00 (95% CI 0.78 to 1.29); (iii) time to six month remission 1.10 (95% CI 0.87 to 1.39) and (iv) time to first seizure 0.91 (95% CI 0.74 to 1.12). The results suggest no overall difference between carbamazepine and phenytoin for these outcomes. Authors' conclusionsWe have not found evidence that a significant difference exists between carbamazepine and phenytoin for the outcomes examined in this review. Confidence intervals are wide and the possibility of important differences existing has not been excluded. |