Article type
Year
Abstract
Context: Epilepsy is a common neurological condition, in which people experience recurrent, unprovoked seizures and accounts for 1% of the total global burden of disease. Two types of epileptic seizures are studied within this review, focal seizures that start in one area of the brain, and generalised onset tonic‐clonic seizures that start in both cerebral hemispheres simultaneously.
With effective drug treatment, up to 70% of individuals with active epilepsy have the potential to become seizure free and go into long-term remission of seizures shortly after starting therapy with a single antiepileptic drug (AED) in monotherapy. Currently in the United Kingdom (UK), the National Institute for Health and Care Excellence (NICE) guidelines for adults and children recommend carbamazepine or lamotrigine as the first treatment options for individuals with newly diagnosed focal seizures and sodium valproate for individuals with newly diagnosed generalised tonic‐clonic seizures. However, a range of other AEDs are available.
Methods: The choice of the first antiepileptic drug for an individual with newly diagnosed seizures is of great importance and should be made after considering high‐quality evidence of how effective the drugs are at controlling seizures and whether they are associated with side effects. It is also important that drugs appropriate for different seizure types are compared to each other.
An individual participant data network meta-analysis (IPD-NMA) can provide relative estimates of how all relevant AEDs compare to each other, incorporating direct and indirect evidence, while taking account of important time-to-event outcomes and different epileptic seizure types.
Our previous Cochrane IPD-NMA published in 2017, considered the time to treatment failure, remission and first seizure of 10 AEDs used as monotherapy in children and adults with focal or generalised onset seizures. Results of this previous review supported current NICE guidelines, and also demonstrated that newer AED levetiracetam may be a good first treatment for focal epilepsy.
We will present the results of an update to our previous review, including two new drugs within the IPD-NMA and new studies published since 2017. A network plot of the evidence included in the updated review is provided in Figure 1. Results of the IPD-NMA will inform 66 pairwise comparisons of the 12 AEDs of interest, including 34 pairwise comparisons which have never been made in head-to-head trials. Challenges related to retrieval of IPD from a range of sources will also be presented.
Patient or healthcare consumer involvement:NICE guidelines within the UK are in the process of being updated. The results of our updated review will provide up to date and high quality evidence to directly inform these guidelines and therefore the treatment of individuals with newly diagnosed seizures within the UK. Results of this updated review will also provide wider, up to date and high quality evidence to inform a choice for decision makers, clinicians or individuals with epilepsy globally.
With effective drug treatment, up to 70% of individuals with active epilepsy have the potential to become seizure free and go into long-term remission of seizures shortly after starting therapy with a single antiepileptic drug (AED) in monotherapy. Currently in the United Kingdom (UK), the National Institute for Health and Care Excellence (NICE) guidelines for adults and children recommend carbamazepine or lamotrigine as the first treatment options for individuals with newly diagnosed focal seizures and sodium valproate for individuals with newly diagnosed generalised tonic‐clonic seizures. However, a range of other AEDs are available.
Methods: The choice of the first antiepileptic drug for an individual with newly diagnosed seizures is of great importance and should be made after considering high‐quality evidence of how effective the drugs are at controlling seizures and whether they are associated with side effects. It is also important that drugs appropriate for different seizure types are compared to each other.
An individual participant data network meta-analysis (IPD-NMA) can provide relative estimates of how all relevant AEDs compare to each other, incorporating direct and indirect evidence, while taking account of important time-to-event outcomes and different epileptic seizure types.
Our previous Cochrane IPD-NMA published in 2017, considered the time to treatment failure, remission and first seizure of 10 AEDs used as monotherapy in children and adults with focal or generalised onset seizures. Results of this previous review supported current NICE guidelines, and also demonstrated that newer AED levetiracetam may be a good first treatment for focal epilepsy.
We will present the results of an update to our previous review, including two new drugs within the IPD-NMA and new studies published since 2017. A network plot of the evidence included in the updated review is provided in Figure 1. Results of the IPD-NMA will inform 66 pairwise comparisons of the 12 AEDs of interest, including 34 pairwise comparisons which have never been made in head-to-head trials. Challenges related to retrieval of IPD from a range of sources will also be presented.
Patient or healthcare consumer involvement:NICE guidelines within the UK are in the process of being updated. The results of our updated review will provide up to date and high quality evidence to directly inform these guidelines and therefore the treatment of individuals with newly diagnosed seizures within the UK. Results of this updated review will also provide wider, up to date and high quality evidence to inform a choice for decision makers, clinicians or individuals with epilepsy globally.