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. 2000;2000(3):CD001030.
doi: 10.1002/14651858.CD001030.

Carbamazepine versus valproate monotherapy for epilepsy

A G Marson  1 , P R Williamson, J L Hutton, H E Clough, D W Chadwick
Affiliations

Carbamazepine versus valproate monotherapy for epilepsy

A G Marson et al. Cochrane Database Syst Rev. 2000.

Abstract

Background: Carbamazepine and valproate are drugs of first choice for epilepsy. Despite the lack of hard evidence from individual randomized controlled trials, there is strong clinical belief that valproate is the drug of choice for generalized epilepsies and carbamazepine for partial epilepsies.

Objectives: To overview the best evidence comparing carbamazepine and valproate monotherapy

Search strategy: Our search strategy included: (a) MEDLINE 1966-99, (b) The Cochrane Library 1999 issue 4, (c) The trial register of the Cochrane Epilepsy Group (d) the pharmaceutical industry.

Selection criteria: Randomized controlled trials comparing carbamazepine and valproate monotherapy for epilepsy.

Data collection and analysis: This was an individual patient data review. Outcome measures were time to withdrawal of allocated treatment, time to 12 month remission, and time to first seizure post randomization. Data were analysed using the stratified Logrank test with results expressed as hazard ratios (HR) (95% CI), where HR>1 indicates an event is more likely on valproate. A test for an interaction between treatment and epilepsy type (partial versus generalized) was also undertaken.

Main results: Results Data were available for 1265 patients from five trials, representing 85% of the patients recruited into the eight trials that met our inclusion criteria. The main overall results (HR 95% CI) were: Time to treatment withdrawal 0.97 (0.79-1.18), 12 month remission 0.87 (0.74-1.02), first seizure 1.09 (0.96-1.25) suggesting no overall difference for these outcomes. The test for an interaction between treatment and epilepsy type was non significant for time to treatment withdrawal and 12 month remission, but significant for time to first seizure. The age distribution of adults classified as having a generalized epilepsy indicate that significant numbers of patients may have had their epilepsy misclassified.

Reviewer's conclusions: We have found some evidence to support the policy of using carbamazepine as the first treatment of choice in partial epilepsies, but no evidence to support the choice of valproate in generalized epilepsies, but confidence intervals are too wide to confirm equivalence. Misclassification of patients may have confounded our results, and has important implications for the design and conduct of future trials.

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Conflict of interest statement

Tony Marson has received hospitality form Sanofi‐Synthelabo (manufacturers of valproate as Epilim). David Chadwick has received hospitality and undertaken consultancy work for Sanofi‐Synthelabo (manufacturers of valproate as Epilim), and Novartis (manufacturers of carbamazepine as Tegretol).

Figures

1.1
1.1. Analysis
Comparison 1 Carbamazepine versus valproate, Outcome 1 Time to treatment withdrawal.
1.2
1.2. Analysis
Comparison 1 Carbamazepine versus valproate, Outcome 2 Time to 12‐month remission from seizures.
1.3
1.3. Analysis
Comparison 1 Carbamazepine versus valproate, Outcome 3 Time to first seizure post randomization.
See this image and copyright information in PMC

References

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