Journal of Neurology

, Volume 265, Issue 1, pp 1–11 | Cite as

Efficacy and safety of antiepileptic drugs for refractory partial-onset epilepsy: a network meta-analysis

  • Qingting Hu
  • Fang Zhang
  • Wenhui Teng
  • Fangfang Hao
  • Jing Zhang
  • Mingxiao Yin
  • Naidong Wang
Review
First Online:
Received:
Revised:
Accepted:

Abstract

The optimal combination of antiepileptic drugs (AEDs) for the treatment of refractory partial-onset epilepsy is a perpetual point of debate. While several network meta-analyses (NMAs) have been published, conclusions remain controversial, especially since newer AEDs have been introduced. In our review, we included the newer AEDs to evaluate the comparative efficacy and safety of AEDs for the treatment of refractory partial-onset epilepsy. We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials (Cochrane Library 2017, Issue 1) from their inception to February 18, 2017. The risk of bias in the included randomized controlled trials (RCTs) was evaluated according to the Cochrane Collaboration’s risk of bias tool. An NMA was performed with a Bayesian random-effects model, and we used the surface under the cumulative ranking curve to detect the optimal AEDs. Seventy-six RCTs with 17 AEDs and 20,711 patients were included in the NMAs, which showed that Brivaracetam (BRV), Levetiracetam (LEV), Oxcarbazepine (OXC), Topiramate, Vigabatrin (VGB), and Valproate (VPA) had a greater likelihood of allowing patients to achieve seizure freedom. We also found that LEV was associated with a lower withdrawal rate due to adverse effects than Lacosamide, Eslicarbazepine acetate, OXC, Pregabalin, and Retigabine. LEV, VGB, VPA, and BRV emerged as the agents with the best combination of properties when considering the efficacy and safety outcomes based on the full double-blind treatment period. However, it is critical to perform RCTs and to obtain prospective data from representative cohort studies.

Keywords

Antiepileptic drugs Epilepsy Meta-analysis Partial 
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Notes

Compliance with ethical standards

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Funding source

This study was financially supported by Grants from the Natural Science Foundation of Shandong Province of China, no. ZR2016 HM 46, Innovation and Entrepreneurship Training Program of undergraduate student in Qingdao University. No. 201611065160.

Supplementary material

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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Neurology of the Affiliated Hospital of Qing Dao UniversityQingdaoChina
  2. 2.Department of PharmacologyQing Dao University School of PharmacyQingdaoChina

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