Efficacy, Tolerability and Safety of Add-on Third-generation Antiseizure Medications in Treating Focal Seizures Worldwide: a Network Meta-analysis of Randomised, Placebo-controlled Trials

Overview

Journal EClinicalMedicine

Specialty General Medicine

Date 2024 Mar 7

PMID 38449838

Authors

Yankun Chen

Wenze Li

Chenfei Lu

Xinxia Gao

Huizhen Song

Yanli Zhang

Sihao Zhao

Gaoang Cai

Qing Guo

Dongdong Zhou

Yangmei Chen

Affiliations

Soon will be listed here.

Abstract

Background: Adjunctive newer antiseizure medications (ASMs) are being used in patients with treatment-resistant focal-onset seizures (FOS). An updated network meta-analysis (NMA) was necessary to compile evidence in this critical area.

Methods: We systematically searched PubMed, Embase, Cochrane Library, Web of Science, and Scopus from their inception until 17 January 2024, evaluating the efficacy, tolerability, and safety of rufinamide (RUF), brivaracetam (BRV), cenobamate (CNB), eslicarbazepine (ESL), lacosamide (LCM), retigabine (RTG), and perampanel (PER) as adjunctive treatments for FOS. Efficacy outcomes included seizure response and seizure freedom. Tolerability was assessed by discontinuation due to adverse events (AEs). Safety outcomes were evaluated based on the number of patients experiencing at least one AE and serious adverse events (SAEs). This review is registered with PROSPERO (CRD42023485130).

Findings: A total of 29 studies involving 11,750 participants were included. For seizure response, all ASMs were significantly superior to placebo, with RTG ranking highest, followed by CNB. Considering dosage, CNB 400 mg/d was top-ranked, followed by RTG 1200 mg/d. For seizure freedom, BRV was highest-ranked, followed by CNB, with BRV 100 mg/d leading, followed by CNB 400 mg/d. Regarding tolerability, LCM 600 mg/d had the lowest ranking, followed by CNB 400 mg/d. For the safety outcome of AEs, ESL 1200 mg/d was ranked lowest, followed by CNB 400 mg/d. Regarding SAEs, LCM 400 mg/d was ranked lowest, followed by RTG 1200 mg/d.

Interpretation: ASMs at different dosages have varying efficacy and tolerability profiles. We have provided hierarchical rankings of ASMs for efficacy and safety outcomes. Our findings offer the most comprehensive evidence available to inform patients, families, physicians, guideline developers, and policymakers about the choice of ASMs in patients with treatment-resistant FOS.

Funding: None.

Citing Articles

Long-Term Safety and Efficacy of Lacosamide Combined with NOACs in Post-Stroke Epilepsy and Atrial Fibrillation: A Prospective Longitudinal Study.

Mangiardi M, Pezzella F, Cruciani A, Alessiani M, Anticoli S J Pers Med. 2024; 14(12).

PMID: 39728038 PMC: 11679913. DOI: 10.3390/jpm14121125.

Efficacy and safety of add-on antiseizure medications for focal epilepsy: A network meta-analysis.

Zhang H, Ou Z, Zhang E, Liu W, Hao N, Chen Y Epilepsia Open. 2024; 9(4):1550-1564.

PMID: 38888005 PMC: 11296132. DOI: 10.1002/epi4.12997.

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