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Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2003-. doi: 10.1002/14651858.CD003615.pub3

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet].

Oxcarbazepine versus phenytoin monotherapy for epilepsy

This version published: 2013; Review content assessed as up-to-date: January 22, 2013.

Link to full article: [Cochrane Library]

Plain language summary

Epilepsy is a disorder where recurrent seizures are caused by abnormal electrical discharges from the brain. Most seizures can be controlled by a single antiepileptic drug. Worldwide, phenytoin is a commonly used antiepileptic drug and oxcarbazepine is one of a newer generation of antiepileptic drugs. The review found that the new drug, oxcarbazepine, when used as a single treatment, is less likely than phenytoin to be withdrawn for reasons of efficacy (seizure control) or tolerability (adverse effects) for participants with partial epilepsy. There is no evidence of a difference between withdrawal rates of the two drugs for participants with generalised seizures. There is also no evidence of a difference between the two drugs in terms of seizure recurrence or remission for both partial and generalised epilepsy, however the design of the studies included in this review may have influenced these seizure and remission outcomes.

Abstract

Background: This is an updated version of the original Cochrane review published in The Cochrane Library 2006, Issue 2.

Worldwide, phenytoin is a commonly used antiepileptic drug. For the newer drugs such as oxcarbazepine, it is important to know how they compare with standard treatments.

Objectives: To review the best evidence comparing oxcarbazepine and phenytoin when used as monotherapy in participants with partial onset seizures or generalised tonic‐clonic seizures with or without other generalised seizure types.

Search methods: We searched the Cochrane Epilepsy Group's Specialised Register (22 January 2013), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2012, Issue 12) and MEDLINE (1946 to 22 January 2013). We handsearched relevant journals and contacted pharmaceutical companies, original trial investigators and experts in the field.

Selection criteria: Randomised controlled trials in children or adults with partial onset seizures or generalised onset tonic‐clonic seizures with a comparison of oxcarbazepine monotherapy with phenytoin monotherapy.

Data collection and analysis: This was an individual participant data review. Outcomes were time to (a) treatment withdrawal (b) 12‐month remission (c) six‐month remission and (d) first seizure post randomisation. We used Cox proportional hazards models to obtain study‐specific estimates of hazard ratios (HR) with 95% confidence intervals (CI) with the generic inverse variance method used to obtain the overall pooled HR and 95% CI.

Main results: Individual participant data were available for 480 out of 517 participants (93%) from three included trials. For remission outcomes, a HR > 1 indicates an advantage to phenytoin and for first seizure and withdrawal outcomes a HR > 1 indicates an advantage to oxcarbazepine.

The main overall results (pooled HR, 95% CI) were: (i) time to withdrawal of allocated treatment 1.65 (1.08 to 2.52), (ii) time to 12‐month remission 0.92 (0.68 to 1.24), (iii) time to six‐month remission 0.90 (0.70 to 1.15), (iv) time to first seizure 1.07 (0.83 to 1.39). Results indicate a statistically significant advantage for oxcarbazepine over phenytoin for time to treatment withdrawal, but insufficient evidence to suggest a difference between the drugs for other outcomes. By epilepsy type, there is no significant advantage for either drug for generalised epilepsy, however there is a significant advantage for partial epilepsy with oxcarbazepine for time to treatment withdrawal (HR 1.95; 95% CI 1.15 to 3.33).

Authors' conclusions: For participants with partial onset seizures oxcarbazepine is significantly less likely to be withdrawn, but current data do not allow a statement as to whether oxcarbazepine is equivalent, superior or inferior to phenytoin in terms of seizure control. However, the design of the studies may have biased seizure outcomes and misclassification of epilepsy type may have biased withdrawal rates.

Editorial Group: Cochrane Epilepsy Group.

Publication status: New search for studies and content updated (no change to conclusions).

Citation: Nolan SJ, Muller M, Tudur Smith C, Marson AG. Oxcarbazepine versus phenytoin monotherapy for epilepsy. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD003615. DOI: 10.1002/14651858.CD003615.pub3. Link to Cochrane Library. [PubMed: 23728645]

Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

PMID: 23728645

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