Phenytoin versus valproate monotherapy for partial onset seizures and generalized onset tonic-clonic seizures
Sübutlu məlumatların xülasələri
16.10.2017 • Sonuncu dəyişiklik 16.10.2017
Editors
There may be no difference between phenytoin and valproate for partial onset seizures and generalized onset tonic-clonic seizures.
A Cochrane review included 5 studies with a total of 669 subjects. Results apply to partial onset seizures (simple, complex and secondary generalised tonic-clonic seizures), and generalised tonic-clonic seizures, but not other generalised seizure types (absence or myoclonus seizure types). For remission outcomes: HR > 1 indicates an advantage for phenytoin; and for first seizure and withdrawal outcomes: HR > 1 indicates an advantage for valproate.
The main overall results (pooled HR adjusted for seizure type) were time to: (a) withdrawal of allocated treatment 1.09 (95% CI 0.76 to 1.55); (b) achieve 12-month remission 0.98 (95% CI 0.78 to 1.23); (c) achieve six-month remission 0.95 (95% CI 0.78 to 1.15); and (d) first seizure 0.93 (95% CI 0.75 to 1.14). The results suggest no overall difference between the drugs for these outcomes. We did not find any statistical interaction between treatment and seizure type (partial versus generalised).
Time to withdrawal of allocated treatment (5 trials, n=528): For subjects with generalized seizures the pooled hazard ratio (HR) was 0.98 (95% CI 0.60 to 1.58); for subjects with partial onset seizures the HR was 1.23 (95% CI 0.77 to 1.98) in favour of valproate. Time to achieve 12 month remission (4 trials, n=514): For subjects with generalized seizures the pooled HR was 1.06 (95% CI 0.71 to 1.57), and for subjects with partial onset seizures the pooled HR was 1.02 (95% CI 0.68 to 1.54). Time to
first seizure post randomization (5 trials, n=639): For subjects with generalized seizures the pooled HR was 1.03 (95% CI 0.77 to 1.39), and for subjects with partial onset seizures the pooled HR was 0.81 (95% CI 0.59 to 1.11) suggesting a potential advantage for phenytoin. There was no evidence supporting the policy of using valproate in generalized tonic-clonic seizures and phenytoin in partial onset seizures.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in patients: children and adults) and indirectness (differences in seizure types).
Ədəbiyyat
- . "?>Nolan SJ, Marson AG, Weston J et al. Phenytoin versus valproate monotherapy for partial onset seizures and generalised onset tonic-clonic seizures: an individual participant data review. Cochrane Database Syst Rev 2016;(4):CD001769.