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Abstract：
OBJECTIVE: Several antiseizure medications (ASMs) have been approved for the treatment of focal epilepsy. However, there is a paucity of evidence on direct comparison of ASMs. We evaluated the comparative efficacy and safety of all approved add-on ASMs for the treatment of focal epilepsy using network meta-analysis.
METHODS: Data through extensive literature search was retrieved from PubMed, Embase, Cochrane, and ClinicalTrial.gov databases using predefined search terms from inception through March 2023. PRISMA reporting guidelines (CRD42023403450) were followed in this study. Efficacy outcomes assessed were ≥50%, ≥75%, and 100% responder rates. Patient retention rate and safety outcomes such as overall treatment-emergent adverse events (TEAEs) and individual TEAEs were assessed. \"Gemtc\" 4.0.4 package was used to perform Bayesian analysis. Outcomes are reported as relative risks (RRs) and 95% confidence interval (CI).
RESULTS: Literature search retrieved 5807 studies of which, 75 studies were included in the analysis. All ASMs showed significantly higher ≥50% responder rate compared with placebo. Except the ≥75% seizure frequency reduction for zonisamide (2.23; 95% CI: 1.00-5.70) and 100% for rufinamide (2.03; 95% CI: 0.54-11.00), all other interventions showed significantly higher ≥75% and 100% responder rates compared with placebo. Among treatments, significantly higher 100% responder rate was observed with cenobamate compared to eslicarbazepine (10.71; 95% CI: 1.56-323.9) and zonisamide (10.63; 95% CI: 1.37-261.2). All ASMs showed a lower patient retention rate compared to placebo, with the least significant value observed for oxcarbazepine (0.77; 95% CI: 0.7-0.84). Levetiracetam showed a lower risk of incidence (1.0; 95%CI: 0.94-1.1; SUCRA: 0.885067) for overall TEAE compared with other medications.
CONCLUSIONS: All approved ASMs were effective as add-on treatment for focal epilepsy. Of the ASMs included, cenobamate had the greatest likelihood of allowing patients to attain seizure freedom.
CONCLUSIONS: This article compares the efficacy and safety of antiseizure medications (ASMs) currently available to neurologists in the treatment of epileptic patients. Several newer generation ASMs that have been developed may be as effective or better than the older medications. We included 75 studies in the analysis. In comparison, all drugs improved ≥50%, ≥75% and 100% responder rates compared to control, except for Zonisamide and Rufinamide in the ≥75% and 100% responder rate categories. Retention of patients undergoing treatment was lower in drugs than placebo. All drugs were tolerated, the levetiracetam showed the best tolerability. Cenobamate more likely help completely to reduce seizures.
METHODS: Data through extensive literature search was retrieved from PubMed, Embase, Cochrane, and ClinicalTrial.gov databases using predefined search terms from inception through March 2023. PRISMA reporting guidelines (CRD42023403450) were followed in this study. Efficacy outcomes assessed were ≥50%, ≥75%, and 100% responder rates. Patient retention rate and safety outcomes such as overall treatment-emergent adverse events (TEAEs) and individual TEAEs were assessed. \"Gemtc\" 4.0.4 package was used to perform Bayesian analysis. Outcomes are reported as relative risks (RRs) and 95% confidence interval (CI).
RESULTS: Literature search retrieved 5807 studies of which, 75 studies were included in the analysis. All ASMs showed significantly higher ≥50% responder rate compared with placebo. Except the ≥75% seizure frequency reduction for zonisamide (2.23; 95% CI: 1.00-5.70) and 100% for rufinamide (2.03; 95% CI: 0.54-11.00), all other interventions showed significantly higher ≥75% and 100% responder rates compared with placebo. Among treatments, significantly higher 100% responder rate was observed with cenobamate compared to eslicarbazepine (10.71; 95% CI: 1.56-323.9) and zonisamide (10.63; 95% CI: 1.37-261.2). All ASMs showed a lower patient retention rate compared to placebo, with the least significant value observed for oxcarbazepine (0.77; 95% CI: 0.7-0.84). Levetiracetam showed a lower risk of incidence (1.0; 95%CI: 0.94-1.1; SUCRA: 0.885067) for overall TEAE compared with other medications.
CONCLUSIONS: All approved ASMs were effective as add-on treatment for focal epilepsy. Of the ASMs included, cenobamate had the greatest likelihood of allowing patients to attain seizure freedom.
CONCLUSIONS: This article compares the efficacy and safety of antiseizure medications (ASMs) currently available to neurologists in the treatment of epileptic patients. Several newer generation ASMs that have been developed may be as effective or better than the older medications. We included 75 studies in the analysis. In comparison, all drugs improved ≥50%, ≥75% and 100% responder rates compared to control, except for Zonisamide and Rufinamide in the ≥75% and 100% responder rate categories. Retention of patients undergoing treatment was lower in drugs than placebo. All drugs were tolerated, the levetiracetam showed the best tolerability. Cenobamate more likely help completely to reduce seizures.
摘要：
目的：几种抗癫痫药物（ASM）已被批准用于治疗局灶性癫痫。然而,缺乏直接比较ASM的证据。我们使用网络荟萃分析评估了所有批准的附加ASM治疗局灶性癫痫的比较疗效和安全性。
方法：通过广泛的文献检索从PubMed检索数据，Embase,科克伦,和ClinicalTrial.gov数据库使用预定义的搜索词从开始到2023年3月。本研究遵循PRISMA报告指南（CRD42023403450）。评估的疗效结果≥50%，≥75%,和100％的响应率。评估患者保留率和安全性结果，例如总体治疗引起的不良事件（TEAE）和个体TEAE。使用“Gemtc”4.0.4软件包进行贝叶斯分析。结果报告为相对风险(RR)和95%置信区间(CI)。
结果：文献检索检索到5807项研究，75项研究纳入分析。与安慰剂相比，所有ASM显示出显著高于≥50%的应答率。除了唑尼沙胺的发作频率降低≥75％（2.23;95％CI：1.00-5.70）和鲁非胺的100％（2.03;95％CI：0.54-11.00）外，与安慰剂相比,所有其他干预措施均显示出显著高于≥75%和100%的应答率.在治疗中，与埃斯利卡巴西平(10.71;95%CI:1.56~323.9)和唑尼沙胺(10.63;95%CI:1.37~261.2)相比,西诺氨酸组的应答率显著更高.与安慰剂相比，所有ASM的患者保留率都较低，与奥卡西平观察到的最不显著的值(0.77;95%CI:0.7-0.84)。与其他药物相比，左乙拉西坦显示总体TEAE的发生率较低（1.0;95CI：0.94-1.1;SUCRA：0.885067）。
结论：所有批准的ASM作为局灶性癫痫的附加治疗有效。包括ASM，cenobamate有最大的可能性允许患者获得癫痫发作的自由。
结论：本文比较了目前神经科医生可用的抗癫痫药物（ASM）治疗癫痫患者的疗效和安全性。已经开发的几种新一代ASM可能与旧药物一样有效或更好。我们在分析中纳入了75项研究。相比之下,所有药物改善≥50%，与对照组相比，应答率≥75%和100%，除了唑尼沙胺和Rufinamide在≥75%和100%应答率类别。接受治疗的患者在药物中的保留率低于安慰剂。所有药物均耐受,左乙拉西坦的耐受性最好。Cenobamate更可能有助于完全减少癫痫发作。
方法：通过广泛的文献检索从PubMed检索数据，Embase,科克伦,和ClinicalTrial.gov数据库使用预定义的搜索词从开始到2023年3月。本研究遵循PRISMA报告指南（CRD42023403450）。评估的疗效结果≥50%，≥75%,和100％的响应率。评估患者保留率和安全性结果，例如总体治疗引起的不良事件（TEAE）和个体TEAE。使用“Gemtc”4.0.4软件包进行贝叶斯分析。结果报告为相对风险(RR)和95%置信区间(CI)。
结果：文献检索检索到5807项研究，75项研究纳入分析。与安慰剂相比，所有ASM显示出显著高于≥50%的应答率。除了唑尼沙胺的发作频率降低≥75％（2.23;95％CI：1.00-5.70）和鲁非胺的100％（2.03;95％CI：0.54-11.00）外，与安慰剂相比,所有其他干预措施均显示出显著高于≥75%和100%的应答率.在治疗中，与埃斯利卡巴西平(10.71;95%CI:1.56~323.9)和唑尼沙胺(10.63;95%CI:1.37~261.2)相比,西诺氨酸组的应答率显著更高.与安慰剂相比，所有ASM的患者保留率都较低，与奥卡西平观察到的最不显著的值(0.77;95%CI:0.7-0.84)。与其他药物相比，左乙拉西坦显示总体TEAE的发生率较低（1.0;95CI：0.94-1.1;SUCRA：0.885067）。
结论：所有批准的ASM作为局灶性癫痫的附加治疗有效。包括ASM，cenobamate有最大的可能性允许患者获得癫痫发作的自由。
结论：本文比较了目前神经科医生可用的抗癫痫药物（ASM）治疗癫痫患者的疗效和安全性。已经开发的几种新一代ASM可能与旧药物一样有效或更好。我们在分析中纳入了75项研究。相比之下,所有药物改善≥50%，与对照组相比，应答率≥75%和100%，除了唑尼沙胺和Rufinamide在≥75%和100%应答率类别。接受治疗的患者在药物中的保留率低于安慰剂。所有药物均耐受,左乙拉西坦的耐受性最好。Cenobamate更可能有助于完全减少癫痫发作。
