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Meta-Analysis
. 2020 Sep 14;50(4):118-136.

Efficacy and Tolerability of Lamotrigine in Borderline Personality Disorder: A Systematic Review and Meta-Analysis

Mehak Pahwa  1 , Nicolas A Nuñez  1 , Boney Joseph  1 , Ashok Seshadri  1 , Danielle J Gerberi  1 , Mark A Frye  1 , Balwinder Singh  1
Affiliations
Meta-Analysis

Efficacy and Tolerability of Lamotrigine in Borderline Personality Disorder: A Systematic Review and Meta-Analysis

Mehak Pahwa et al. Psychopharmacol Bull. .

Abstract

Background: Patients with Borderline Personality Disorder (BPD) have a high prevalence of mood disorders. Lamotrigine (LAM) is often used as an off-label therapeutic option for BPD. We aimed to conduct a systematic review and meta-analysis to assess the efficacy and tolerability of LAM for the treatment of BPD.

Methods: We comprehensively searched electronic databases for eligible studies from the inception of databases to September 2019. Outcomes investigated were BPD dimensions, tolerability, and adverse events. Quality assessments were completed for the included studies. Data were summarized using random-effects model.

Results: Of the 619 records, five studies, including three randomized controlled trials (RCT; N = 330) were included for the qualitative analysis. A meta-analysis conducted on two RCTs measuring LAM efficacy at 12 weeks, showed no statistically significant difference at 12 weeks (SMD: -0.04; 95% CI: -0.49, 0.41; p = 0.87; I2 = 38%) and at study endpoints (SMD: 0.18, 95%CI: -0.89, 1.26; p = 0.74; I2 = 86%) as compared to placebo. Sensitivity analysis on three RCTs measuring impulsivity/aggression showed no statistically significant difference between LAM and placebo (SMD: -1.84, 95% CI: -3.94, 0.23; p = 0.08; I2 = 95%). LAM was well tolerated, and quality assessment of the included trials was good.

Conclusions: Our results suggest there is limited data regarding efficacy of lamotrigine in BPD. There was no consistent evidence of lamotrigine's efficacy for the core symptom domains of BPD. Future studies should focus on examining targeted domains of BPD to clarify sub-phenotypes and individualized treatment for patients with BPD.

Keywords: ZAN-BPD; affective lability; bipolar disorder; borderline personality disorder; depression; efficacy; lamotrigine.

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Conflict of interest statement

Financial Disclosures Dr. Singh received research time support from Medibio. It is unrelated to the current study. Dr. Singh reports grant support from Mayo Clinic. Dr. Frye reports grant support from Assurex Health, Mayo Foundation, Medibio. Consultant (Mayo)—Actify Neurotherapies, Allergan, Intra-Cellular Therapies, Inc., Janssen, Myriad, Neuralstem Inc., Takeda, Teva Pharmaceuticals. He reports CME/Travel/Honoraria from the American Physician Institute, CME Outfitters, Global Academy for Medical Education. Other authors have none to declare. All authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure S1
Figure S1
Risk of bias for RCTs Included in Meta-Analysis
Figure 1
Figure 1
Flow Diagram of the Procedure for Study Selection
Figure 2
Figure 2
Forest Plot of Pooled ZAN-BPD Standardized Mean Differences for Efficacy of Lamotrigine at 12 Weeks
Figure 3
Figure 3
Forest Plot of Pooled ZAN-BPD Standardized Mean Differences for Efficacy of Lamotrigine at Endpoint
Figure 4
Figure 4
Forest Plot of Pooled Impulsivity/Aggression Standardized Mean Differences for Efficacy of Lamotrigine
See this image and copyright information in PMC

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