"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"

作者全名："Chen, Yankun; Li, Wenze; Lu, Chenfei; Gao, Xinxia; Song, Huizhen; Zhang, Yanli; Zhao, Sihao; Cai, Gaoang; Guo, Qing; Zhou, Dongdong; Chen, Yangmei"

作者地址："[Chen, Yankun; Li, Wenze; Chen, Yangmei] Chongqing Med Univ, Affiliated Hosp 2, Dept Neurol, 74 Linjiang Rd, Chongqing 400010, Peoples R China; [Lu, Chenfei] Ninth Peoples Hosp Chongqing, Dept Resp, Chongqing 400700, Peoples R China; [Gao, Xinxia] Heze Municipal Hosp, Dept Med Records, Heze 274000, Peoples R China; [Song, Huizhen] Heze Third Peoples Hosp, Dept Neurol, Heze 274000, Peoples R China; [Zhang, Yanli] Shandong Prov Hosp, Dept Neurol, Heze Branch, Heze 274000, Peoples R China; [Zhao, Sihao] Heze Mudan Dist Peoples Hosp, Dept Neurol, Heze 274000, Peoples R China; [Cai, Gaoang] Juancheng Cty Peoples Hosp, Dept Neurol, Juancheng 274600, Peoples R China; [Guo, Qing] Heze Municipal Hosp, Dept Neurol, Brain Hosp, Heze 274000, Peoples R China; [Zhou, Dongdong] Chongqing Med Univ, Mental Hlth Ctr, Univ Town Hosp, 55 Univ Town Middle Rd, Chongqing 401331, Peoples R China"

通信作者："Chen, YM (通讯作者)，Chongqing Med Univ, Affiliated Hosp 2, Dept Neurol, 74 Linjiang Rd, Chongqing 400010, Peoples R China.; Zhou, DD (通讯作者)，Chongqing Med Univ, Mental Hlth Ctr, Univ Town Hosp, 55 Univ Town Middle Rd, Chongqing 401331, Peoples R China."

来源：ECLINICALMEDICINE

ESI学科分类：　

WOS号：WOS:001202264200001

JCR分区：Q1

影响因子：9.6

年份：2024

卷号：70

期号：　

开始页：　

结束页：　

文献类型：Article

关键词：Focal seizures; Seizure; Epilepsy; Antiseizure medications; Network meta -analysis

摘要："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. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd."

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