Epilepsy

 SANAD Arm A: Marson, AG. The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial. Lancet 2007. - RCT, unblinded - N = 1721 - Randomized to carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate - Patients: Partial epilepsy - Primary Outcomes: Time to treatment failure, time to 12-months remission, assessment was by both intention to treat and per protocol - Results: - Conclusion: Lamotrigine is clinically better than carbamazepine is clinically better than carbamazepine for time to treatment failure outcomes in partial onset seizures.
 * Time to treatment failure: lamotrigine significantly better than carbamazepine, gabapentin, and topiramate. Lamotrigine non-significant advantage vs oxcarbazepine.
 * Time to 12-month remission: Carbamazepine significantly better than gabapentin. Carbamazepine non-significant advantage vs lamotrigine, topiramate, oxcarbazepine.

SANAD Arm B (2007): Marson et al. “The SANAD study of effectiveness of valproate, lamotrigine, or topiramate for generalised and unclassifiable epilepsy: an unblinded randomised controlled trial.” Lancet 2007, 369:9566 (1016-1026). - RCT, unblended - Generalized onset seizures or seizures that are difficult to classify. Hospital based outpatient clinics in UK. - N=716 - Randomly assigned to valproate, lamotrigine, or topiramate - Primary Outcomes: Time to treatment failure and time to 1-year remission <span style="font-family: 'Times New Roman',Times,serif;">- Results: <span style="font-family: 'Times New Roman',Times,serif;">- Conclusion: Valproate is better tolerated than topiramate, more efficacious than lamotrigine, should remain drug of first choice for generalized and unclassified epilepsies.
 * <span style="font-family: 'Times New Roman',Times,serif;">Time to treatment failure: valproate significantly better than topiramate (HR 1.57, 95% CI 1.19-2.08). No significant difference between valproate and lamotrigine (1.25, 0.94-1.68)
 * <span style="font-family: 'Times New Roman',Times,serif;">For idiopathic generalized epilepsy subgroup, valproate significantly outperformed lamotrigine and topiramate.
 * <span style="font-family: 'Times New Roman',Times,serif;">Time to 12-month remission: valproate significantly better than lamotrigine (0.76, 0.62-0.95). No sigifncant difference between valproate and topiramate.
 * <span style="font-family: 'Times New Roman',Times,serif;">For idiopathic generalized epilepsy subgroup, valproate outperformed lamotrigine (0.68, 0.53-0.89). No significant difference between valproate and topiramate.