Topiramate versus carbamazepine monotherapy for epilepsy

With partial-onset seizures, carbamazepine appears less likely to be withdrawn and 12-month remission appears to be achieved earlier than with topiramate.

Comment: The quality of evidence is downgraded by study quality (one study was of open-label design).

Summary

A Cochrane review included 2 studies with a total of 1151 patients. The results are applicable mainly to patients with partial-onset seizures; 85% of included patients experienced seizures of this type at baseline. For remission outcomes, a HR < 1 indicated an advantage for carbamazepine, and for first seizure and withdrawal outcomes, a HR < 1 indicated an advantage for topiramate. There were no statistically significant differences between the drugs for time to withdrawal of allocated treatment 1.16 (0.98 to 1.38); time to first seizure 1.11 (0.96 to 1.29); and time to 6-month remission 0.88 (0.76 to 1.01). A statistically significant advantage for carbamazepine was shown for time to 12-month remission: 0.84 (0.71 to 1.00). For patients with partial-onset seizures, a statistically significant advantage for carbamazepine was shown for time to withdrawal of allocated treatment (HR 1.20, 95% CI 1.00 to 1.45) and time to 12-month remission (HR 0.84, 95% CI 0.71 to 1.00). No statistically significant differences were apparent between the drugs for other outcomes and for the limited number of patients with generalised-onset tonic-clonic seizures with or without other generalised seizure types or unclassified seizures. The most commonly reported adverse events with both drugs were drowsiness or fatigue, ‘pins and needles’ (tingling sensation), headache, GI disturbance and anxiety or depression The rate of adverse events was similar across the two drugs.

Clinical comments

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Ədəbiyyat

1. Nolan SJ, Sudell M, Tudur Smith C et al. Topiramate versus carbamazepine monotherapy for epilepsy: an individual participant data review. Cochrane Database Syst Rev 2016;12():CD012065.