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Meta-Analysis
. 2024 Aug 1;8(8):CD014941.
doi: 10.1002/14651858.CD014941.pub2.

Cenobamate add-on therapy for drug-resistant focal epilepsy

Francesco Brigo  1 , Simona Lattanzi  2
Affiliations
Meta-Analysis

Cenobamate add-on therapy for drug-resistant focal epilepsy

Francesco Brigo et al. Cochrane Database Syst Rev. .

Abstract

Background: Although most people with epilepsy achieve complete seizure cessation, approximately one-third of those with the condition continue experiencing seizures despite the use of antiseizure medications (ASMs) given as monotherapy or polytherapy. In this review, we summarised the evidence from randomised controlled trials (RCTs) about cenobamate as an add-on treatment for focal epilepsy uncontrolled by one or more concomitant ASMs.

Objectives: To assess the efficacy and tolerability of add-on oral cenobamate for the treatment of drug-resistant focal-onset seizures, defined as seizures persisting despite treatment with one or more ASMs.

Search methods: We searched the Cochrane Register of Studies (CRS Web) and MEDLINE Ovid (September 2022). In addition, we contacted the manufacturer of cenobamate and experts in the field to enquire after any ongoing or unpublished studies.

Selection criteria: RCTs comparing add-on cenobamate to placebo or another ASM in people with focal epilepsy uncontrolled by one or more concomitant ASMs.

Data collection and analysis: Two review authors independently selected trials for inclusion, extracted data, performed risk of bias assessment, and assessed the certainty of the evidence using the GRADE approach. Our primary outcomes were at least a 50% reduction in total seizure frequency, seizure freedom, and the occurrence of adverse events. We used an intention-to-treat approach for our primary analyses. For each outcome we estimated summary risk ratios (RRs) with their 95% confidence intervals (CIs). We summarised the estimates of effects and certainty of the evidence for each outcome in a summary of findings table.

Main results: We included two studies (659 adult participants, 442 allocated to cenobamate and 217 to placebo). The overall RR for at least a 50% reduction in seizure frequency for add-on cenobamate at any dose compared to placebo was 2.17 (52% versus 24%, 95% CI 1.66 to 2.84; 2 studies, 605 participants; moderate-certainty evidence). The RR for seizure freedom for add-on cenobamate at any dose compared to placebo was 4.45 (16% versus 5%, 95% CI 2.25 to 8.78; 2 studies, 605 participants; moderate-certainty evidence). The RR for the occurrence of adverse events for add-on cenobamate at any dose compared to placebo was 1.14 (77% versus 67%, 95% CI 1.02 to 1.27; 2 studies, 659 participants; moderate-certainty evidence). We judged the two included RCTs as at low or unclear risk of bias. Both studies were sponsored by the drug company that produces cenobamate.

Authors' conclusions: Add-on cenobamate is probably better than placebo in reducing the frequency of seizures by at least 50% and in achieving seizure freedom in adults with focal epilepsy uncontrolled by one or more concomitant ASMs (moderate level of certainty). Its use is probably associated with an increased risk of adverse events (moderate level of certainty). Further prospective, controlled trials are required to evaluate the efficacy and tolerability of add-on cenobamate compared to other ASMs. The efficacy and tolerability of cenobamate as adjunctive treatment for focal epilepsy in children should be further investigated. Finally, the long-term efficacy and tolerability of add-on cenobamate treatment in people with other epilepsy types (e.g. generalised epilepsy) or specific epilepsy syndromes, as well as its use as monotherapy, require additional study.

Trial registration: ClinicalTrials.gov NCT03678753.

PubMed Disclaimer

Conflict of interest statement

Francesco Brigo: none known. Francesco, former Editor of the Cochrane Epilepsy Group, was not involved in the editorial process.

Simona Lattanzi: none known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: summary of review authors' judgements about risk of bias for all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: Cenobamate versus placebo (any dose), Outcome 1: 50% responder rate
1.2
1.2. Analysis
Comparison 1: Cenobamate versus placebo (any dose), Outcome 2: Seizure freedom
1.3
1.3. Analysis
Comparison 1: Cenobamate versus placebo (any dose), Outcome 3: Any adverse event
1.4
1.4. Analysis
Comparison 1: Cenobamate versus placebo (any dose), Outcome 4: ≥ 75% seizure reduction/month during the maintenance treatment period compared to baseline
1.5
1.5. Analysis
Comparison 1: Cenobamate versus placebo (any dose), Outcome 5: ≥ 90% seizure reduction/month during the maintenance treatment period compared to baseline
1.6
1.6. Analysis
Comparison 1: Cenobamate versus placebo (any dose), Outcome 6: Withdrawal from the study due to adverse events
1.7
1.7. Analysis
Comparison 1: Cenobamate versus placebo (any dose), Outcome 7: Withdrawal rate
1.8
1.8. Analysis
Comparison 1: Cenobamate versus placebo (any dose), Outcome 8: Any treatment‐related adverse events
1.9
1.9. Analysis
Comparison 1: Cenobamate versus placebo (any dose), Outcome 9: Any serious adverse event
1.10
1.10. Analysis
Comparison 1: Cenobamate versus placebo (any dose), Outcome 10: Cenobamate versus placebo ‐ subgroup analysis, 50% responder rate
1.11
1.11. Analysis
Comparison 1: Cenobamate versus placebo (any dose), Outcome 11: Cenobamate versus placebo ‐ subgroup analysis, seizure freedom
1.12
1.12. Analysis
Comparison 1: Cenobamate versus placebo (any dose), Outcome 12: Cenobamate versus placebo ‐ subgroup analysis, any adverse event
1.13
1.13. Analysis
Comparison 1: Cenobamate versus placebo (any dose), Outcome 13: Cenobamate versus placebo ‐ subgroup analysis, ≥ 75% seizure reduction/month during the maintenance treatment period compared to baseline
1.14
1.14. Analysis
Comparison 1: Cenobamate versus placebo (any dose), Outcome 14: Cenobamate versus placebo ‐ subgroup analysis, ≥ 90% seizure reduction/month during the maintenance treatment period compared to baseline
1.15
1.15. Analysis
Comparison 1: Cenobamate versus placebo (any dose), Outcome 15: Cenobamate versus placebo ‐ subgroup analysis, withdrawal from the study due to adverse events
1.16
1.16. Analysis
Comparison 1: Cenobamate versus placebo (any dose), Outcome 16: Cenobamate versus placebo ‐ subgroup analysis, withdrawal rate
1.17
1.17. Analysis
Comparison 1: Cenobamate versus placebo (any dose), Outcome 17: Cenobamate versus placebo ‐ subgroup analysis, any treatment‐related adverse events
1.18
1.18. Analysis
Comparison 1: Cenobamate versus placebo (any dose), Outcome 18: Cenobamate versus placebo ‐ subgroup analysis, any serious adverse event
1.19
1.19. Analysis
Comparison 1: Cenobamate versus placebo (any dose), Outcome 19: Cenobamate versus placebo ‐ sensitivity analysis, 50% responder rate (random‐effects model)
1.20
1.20. Analysis
Comparison 1: Cenobamate versus placebo (any dose), Outcome 20: Cenobamate versus placebo ‐ sensitivity analysis, seizure freedom (random‐effects model)
1.21
1.21. Analysis
Comparison 1: Cenobamate versus placebo (any dose), Outcome 21: Cenobamate versus placebo ‐ sensitivity analysis, any adverse event (random‐effects model)
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Update of

References

References to studies included in this review

Chung 2020 {published data only}
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References to ongoing studies

EUCTR2018‐001337‐41‐HU {published data only}
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Brigo 2021
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