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. 2020 May 26;5(5):CD009887.
doi: 10.1002/14651858.CD009887.pub5.

Stiripentol add-on therapy for drug-resistant focal epilepsy

Francesco Brigo  1 , Stanley C Igwe  2 , Nicola Luigi Bragazzi  3
Affiliations

Stiripentol add-on therapy for drug-resistant focal epilepsy

Francesco Brigo et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: This is an updated version of the Cochrane Review first published in 2014, and last updated in 2018. For nearly 30% of people with epilepsy, seizures are not controlled by current treatments. Stiripentol is an antiepileptic drug (AED) that was developed in France and was approved by the European Medicines Agency (EMA) in 2007 for the treatment of Dravet syndrome as an adjunctive therapy with valproate and clobazam.

Objectives: To evaluate the efficacy and tolerability of stiripentol as add-on treatment for people with drug-resistant focal epilepsy who are taking AEDs.

Search methods: For the latest update, we searched the following databases on 27 February 2020: Cochrane Register of Studies (CRS Web); and MEDLINE (Ovid, 1946 to 26 February 2020). CRS Web includes randomised or quasi-randomised controlled trials from the Specialized Registers of Cochrane Review Groups including Epilepsy, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (ICTRP). We contacted Biocodex (the manufacturer of stiripentol) and epilepsy experts to identify published, unpublished and ongoing trials.

Selection criteria: Randomised, controlled, add-on trials of stiripentol in people with drug-resistant focal epilepsy.

Data collection and analysis: Review authors independently selected trials for inclusion and extracted data. We investigated outcomes including 50% or greater reduction in seizure frequency, seizure freedom, adverse effects, treatment withdrawal and changes in quality of life.

Main results: On the basis of our selection criteria, we included no new studies in the present review update. We included only one study from the earlier review (32 children with focal epilepsy). This study adopted a responder-enriched design and found no clear evidence of a reduction in seizure frequency (≥ 50% seizure reduction) (risk ratio (RR) 1.51, 95% confidence interval (CI) 0.81 to 2.82; low-certainty evidence) or evidence of seizure freedom (RR 1.18, 95% CI 0.31 to 4.43; low-certainty evidence) when add-on stiripentol was compared with placebo. Stiripentol led to a greater risk of adverse effects considered as a whole (RR 2.65, 95% CI 1.08 to 6.47; low-certainty evidence). When we considered specific adverse events, confidence intervals were very wide and showed the possibility of substantial increases and small reductions in risks of neurological adverse effects (RR 2.65, 95% CI 0.88 to 8.01; low-certainty evidence) and gastrointestinal adverse effects (RR 11.56, 95% CI 0.71 to 189.36; low-certainty evidence). Researchers noted no clear reduction in the risk of study withdrawal (RR 0.66, 95% CI 0.30 to 1.47; low-certainty evidence), which was high in both groups (35.0% in add-on placebo and 53.3% in stiripentol group; low-certainty evidence). The external validity of this study was limited because only responders to stiripentol (i.e. patients experiencing a ≥ 50% decrease in seizure frequency compared with baseline) were included in the randomised, add-on, placebo-controlled, double-blind phase. Furthermore, carry-over and withdrawal effects probably influenced outcomes related to seizure frequency. Very limited information derived from the only included study shows that adverse effects considered as a whole seemed to occur significantly more often with add-on stiripentol than with add-on placebo.

Authors' conclusions: We have found no new studies since the last version of this review was published. Hence, we have made no changes to the conclusions of this update as presented in the initial review. We can draw no conclusions to support the use of stiripentol as add-on treatment for drug-resistant focal epilepsy. Additional large, randomised, well-conducted trials are needed.

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Conflict of interest statement

Francesco Brigo: received travel support and accommodation by Lusofarmaco to attend the annual Congress of the Italian Chapter of ILAE; he received speaking fees from Lusofarmaco. Stanley C Igwe: none known Nicola L Bragazzi: none known

Figures

1
1
Study flow diagram. The results shown in this figure include the original searches conducted for the review and all subsequent updates.
1.1
1.1. Analysis
Comparison 1: Add‐on stiripentol versus placebo, Outcome 1: ≥ 50% seizure reduction
1.2
1.2. Analysis
Comparison 1: Add‐on stiripentol versus placebo, Outcome 2: Seizure freedom
1.3
1.3. Analysis
Comparison 1: Add‐on stiripentol versus placebo, Outcome 3: ≥ 1 adverse effect
1.4
1.4. Analysis
Comparison 1: Add‐on stiripentol versus placebo, Outcome 4: Neurological adverse effects
1.5
1.5. Analysis
Comparison 1: Add‐on stiripentol versus placebo, Outcome 5: Gastrointestinal adverse effects
1.6
1.6. Analysis
Comparison 1: Add‐on stiripentol versus placebo, Outcome 6: Dropouts
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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References to other published versions of this review

Brigo 2012
    1. Brigo F, Storti M. Stiripentol for focal refractory epilepsy. Cochrane Database of Systematic Reviews 2012, Issue 5. [DOI: 10.1002/14651858.CD009887] - DOI - PubMed
Brigo 2014
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Brigo 2015
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Brigo 2018
    1. Brigo F, Igwe SC, Bragazzi NL. Stiripentol add-on therapy for focal refractory epilepsy. Cochrane Database of Systematic Reviews 2018, Issue 5. [DOI: 10.1002/14651858.CD009887.pub4] - DOI - PMC - PubMed

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