Multiple treatment comparisons in epilepsy monotherapy trials View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2007-11-05

AUTHORS

Catrin Tudur Smith, Anthony G Marson, David W Chadwick, Paula R Williamson

ABSTRACT

BackgroundThe choice of antiepileptic drug for an individual should be based upon the highest quality evidence regarding potential benefits and harms of the available treatments. Systematic reviews and meta-analysis of randomised controlled trials should be a major source of evidence supporting this decision making process. We summarise all available individual patient data evidence from randomised controlled trials that compared at least two out of eight antiepileptic drugs given as monotherapy.MethodsMultiple treatment comparisons from epilepsy monotherapy trials were synthesized in a single stratified Cox regression model adjusted for treatment by epilepsy type interactions and making use of direct and indirect evidence. Primary outcomes were time to treatment failure and time to 12 month remission from seizures. A secondary outcome was time to first seizure.ResultsIndividual patient data for 6418 patients from 20 randomised trials comparing eight antiepileptic drugs were synthesized. For partial onset seizures (4628 (72%) patients), lamotrigine, carbamazepine and oxcarbazepine provide the best combination of seizure control and treatment failure. Lamotrigine is clinically superior to all other drugs for treatment failure but estimates suggest a disadvantage compared to carbamazepine for time to 12 month remission [Hazard Ratio (95% Confidence Interval) = 0.87(0.73 to 1.04)] and time to first seizure [1.29(1.13 to 1.48)]. Phenobarbitone may delay time to first seizure [0.77(0.61 to 0.96)] but at the expense of increased treatment failure [1.60(1.22 to 2.10)]. For generalized onset tonic clonic seizures (1790 (28%) patients) estimates suggest valproate or phenytoin may provide the best combination of seizure control and treatment failure but some uncertainty remains about the relative effectiveness of other drugs.ConclusionFor patients with partial onset seizures, results favour carbamazepine, oxcarbazepine and lamotrigine. For generalized onset tonic clonic seizures, results favour valproate and phenytoin. More... »

PAGES

34

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/1745-6215-8-34

DOI

http://dx.doi.org/10.1186/1745-6215-8-34

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1017847472

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/17983480


Indexing Status Check whether this publication has been indexed by Scopus and Web Of Science using the SN Indexing Status Tool
Incoming Citations Browse incoming citations for this publication using opencitations.net

JSON-LD is the canonical representation for SciGraph data.

TIP: You can open this SciGraph record using an external JSON-LD service: JSON-LD Playground Google SDTT

[
  {
    "@context": "https://springernature.github.io/scigraph/jsonld/sgcontext.json", 
    "about": [
      {
        "id": "http://purl.org/au-research/vocabulary/anzsrc-for/2008/11", 
        "inDefinedTermSet": "http://purl.org/au-research/vocabulary/anzsrc-for/2008/", 
        "name": "Medical and Health Sciences", 
        "type": "DefinedTerm"
      }, 
      {
        "id": "http://purl.org/au-research/vocabulary/anzsrc-for/2008/1109", 
        "inDefinedTermSet": "http://purl.org/au-research/vocabulary/anzsrc-for/2008/", 
        "name": "Neurosciences", 
        "type": "DefinedTerm"
      }
    ], 
    "author": [
      {
        "affiliation": {
          "alternateName": "Centre for Medical Statististcs and Health Evaluation, University of Liverpool, Liverpool, UK", 
          "id": "http://www.grid.ac/institutes/grid.10025.36", 
          "name": [
            "Centre for Medical Statististcs and Health Evaluation, University of Liverpool, Liverpool, UK"
          ], 
          "type": "Organization"
        }, 
        "familyName": "Tudur Smith", 
        "givenName": "Catrin", 
        "id": "sg:person.01261374732.97", 
        "sameAs": [
          "https://app.dimensions.ai/discover/publication?and_facet_researcher=ur.01261374732.97"
        ], 
        "type": "Person"
      }, 
      {
        "affiliation": {
          "alternateName": "Division of Neuroscience, University of Liverpool, Liverpool, UK", 
          "id": "http://www.grid.ac/institutes/grid.10025.36", 
          "name": [
            "Division of Neuroscience, University of Liverpool, Liverpool, UK"
          ], 
          "type": "Organization"
        }, 
        "familyName": "Marson", 
        "givenName": "Anthony G", 
        "id": "sg:person.01174075734.81", 
        "sameAs": [
          "https://app.dimensions.ai/discover/publication?and_facet_researcher=ur.01174075734.81"
        ], 
        "type": "Person"
      }, 
      {
        "affiliation": {
          "alternateName": "Division of Neuroscience, University of Liverpool, Liverpool, UK", 
          "id": "http://www.grid.ac/institutes/grid.10025.36", 
          "name": [
            "Division of Neuroscience, University of Liverpool, Liverpool, UK"
          ], 
          "type": "Organization"
        }, 
        "familyName": "Chadwick", 
        "givenName": "David W", 
        "id": "sg:person.0710312561.45", 
        "sameAs": [
          "https://app.dimensions.ai/discover/publication?and_facet_researcher=ur.0710312561.45"
        ], 
        "type": "Person"
      }, 
      {
        "affiliation": {
          "alternateName": "Centre for Medical Statististcs and Health Evaluation, University of Liverpool, Liverpool, UK", 
          "id": "http://www.grid.ac/institutes/grid.10025.36", 
          "name": [
            "Centre for Medical Statististcs and Health Evaluation, University of Liverpool, Liverpool, UK"
          ], 
          "type": "Organization"
        }, 
        "familyName": "Williamson", 
        "givenName": "Paula R", 
        "id": "sg:person.01002370610.91", 
        "sameAs": [
          "https://app.dimensions.ai/discover/publication?and_facet_researcher=ur.01002370610.91"
        ], 
        "type": "Person"
      }
    ], 
    "datePublished": "2007-11-05", 
    "datePublishedReg": "2007-11-05", 
    "description": "BackgroundThe choice of antiepileptic drug for an individual should be based upon the highest quality evidence regarding potential benefits and harms of the available treatments. Systematic reviews and meta-analysis of randomised controlled trials should be a major source of evidence supporting this decision making process. We summarise all available individual patient data evidence from randomised controlled trials that compared at least two out of eight antiepileptic drugs given as monotherapy.MethodsMultiple treatment comparisons from epilepsy monotherapy trials were synthesized in a single stratified Cox regression model adjusted for treatment by epilepsy type interactions and making use of direct and indirect evidence. Primary outcomes were time to treatment failure and time to 12 month remission from seizures. A secondary outcome was time to first seizure.ResultsIndividual patient data for 6418 patients from 20 randomised trials comparing eight antiepileptic drugs were synthesized. For partial onset seizures (4628 (72%) patients), lamotrigine, carbamazepine and oxcarbazepine provide the best combination of seizure control and treatment failure. Lamotrigine is clinically superior to all other drugs for treatment failure but estimates suggest a disadvantage compared to carbamazepine for time to 12 month remission [Hazard Ratio (95% Confidence Interval) = 0.87(0.73 to 1.04)] and time to first seizure [1.29(1.13 to 1.48)]. Phenobarbitone may delay time to first seizure [0.77(0.61 to 0.96)] but at the expense of increased treatment failure [1.60(1.22 to 2.10)]. For generalized onset tonic clonic seizures (1790 (28%) patients) estimates suggest valproate or phenytoin may provide the best combination of seizure control and treatment failure but some uncertainty remains about the relative effectiveness of other drugs.ConclusionFor patients with partial onset seizures, results favour carbamazepine, oxcarbazepine and lamotrigine. For generalized onset tonic clonic seizures, results favour valproate and phenytoin.", 
    "genre": "article", 
    "id": "sg:pub.10.1186/1745-6215-8-34", 
    "isAccessibleForFree": true, 
    "isPartOf": [
      {
        "id": "sg:journal.1297400", 
        "issn": [
          "1468-6708", 
          "1745-6215"
        ], 
        "name": "Trials", 
        "publisher": "Springer Nature", 
        "type": "Periodical"
      }, 
      {
        "issueNumber": "1", 
        "type": "PublicationIssue"
      }, 
      {
        "type": "PublicationVolume", 
        "volumeNumber": "8"
      }
    ], 
    "keywords": [
      "partial-onset seizures", 
      "treatment failure", 
      "first seizure", 
      "antiepileptic drugs", 
      "months remission", 
      "monotherapy trials", 
      "seizure control", 
      "onset seizures", 
      "generalized onset tonic-clonic seizures", 
      "onset tonic-clonic seizures", 
      "treatment comparisons", 
      "tonic-clonic seizures", 
      "Cox regression model", 
      "high-quality evidence", 
      "multiple treatment comparisons", 
      "ConclusionFor patients", 
      "Secondary outcomes", 
      "primary outcome", 
      "clonic seizures", 
      "quality evidence", 
      "available treatments", 
      "seizures", 
      "systematic review", 
      "lamotrigine", 
      "trials", 
      "patient data", 
      "drugs", 
      "remission", 
      "patients", 
      "oxcarbazepine", 
      "phenytoin", 
      "carbamazepine", 
      "regression models", 
      "outcomes", 
      "treatment", 
      "indirect evidence", 
      "failure", 
      "potential benefits", 
      "evidence", 
      "monotherapy", 
      "relative effectiveness", 
      "phenobarbitone", 
      "control", 
      "review", 
      "major source", 
      "harm", 
      "individuals", 
      "time", 
      "combination", 
      "benefits", 
      "comparison", 
      "use", 
      "data", 
      "best combination", 
      "effectiveness", 
      "data evidence", 
      "choice", 
      "estimates", 
      "disadvantages", 
      "decisions", 
      "expense", 
      "model", 
      "interaction", 
      "source", 
      "process", 
      "type interaction", 
      "uncertainty"
    ], 
    "name": "Multiple treatment comparisons in epilepsy monotherapy trials", 
    "pagination": "34", 
    "productId": [
      {
        "name": "dimensions_id", 
        "type": "PropertyValue", 
        "value": [
          "pub.1017847472"
        ]
      }, 
      {
        "name": "doi", 
        "type": "PropertyValue", 
        "value": [
          "10.1186/1745-6215-8-34"
        ]
      }, 
      {
        "name": "pubmed_id", 
        "type": "PropertyValue", 
        "value": [
          "17983480"
        ]
      }
    ], 
    "sameAs": [
      "https://doi.org/10.1186/1745-6215-8-34", 
      "https://app.dimensions.ai/details/publication/pub.1017847472"
    ], 
    "sdDataset": "articles", 
    "sdDatePublished": "2022-10-01T06:34", 
    "sdLicense": "https://scigraph.springernature.com/explorer/license/", 
    "sdPublisher": {
      "name": "Springer Nature - SN SciGraph project", 
      "type": "Organization"
    }, 
    "sdSource": "s3://com-springernature-scigraph/baseset/20221001/entities/gbq_results/article/article_453.jsonl", 
    "type": "ScholarlyArticle", 
    "url": "https://doi.org/10.1186/1745-6215-8-34"
  }
]
 

Download the RDF metadata as:  json-ld nt turtle xml License info

HOW TO GET THIS DATA PROGRAMMATICALLY:

JSON-LD is a popular format for linked data which is fully compatible with JSON.

curl -H 'Accept: application/ld+json' 'https://scigraph.springernature.com/pub.10.1186/1745-6215-8-34'

N-Triples is a line-based linked data format ideal for batch operations.

curl -H 'Accept: application/n-triples' 'https://scigraph.springernature.com/pub.10.1186/1745-6215-8-34'

Turtle is a human-readable linked data format.

curl -H 'Accept: text/turtle' 'https://scigraph.springernature.com/pub.10.1186/1745-6215-8-34'

RDF/XML is a standard XML format for linked data.

curl -H 'Accept: application/rdf+xml' 'https://scigraph.springernature.com/pub.10.1186/1745-6215-8-34'


 

This table displays all metadata directly associated to this object as RDF triples.

151 TRIPLES      20 PREDICATES      92 URIs      84 LITERALS      7 BLANK NODES

Subject Predicate Object
1 sg:pub.10.1186/1745-6215-8-34 schema:about anzsrc-for:11
2 anzsrc-for:1109
3 schema:author N3ecb96eb02724b63bfd4c3ae1ea4a059
4 schema:datePublished 2007-11-05
5 schema:datePublishedReg 2007-11-05
6 schema:description BackgroundThe choice of antiepileptic drug for an individual should be based upon the highest quality evidence regarding potential benefits and harms of the available treatments. Systematic reviews and meta-analysis of randomised controlled trials should be a major source of evidence supporting this decision making process. We summarise all available individual patient data evidence from randomised controlled trials that compared at least two out of eight antiepileptic drugs given as monotherapy.MethodsMultiple treatment comparisons from epilepsy monotherapy trials were synthesized in a single stratified Cox regression model adjusted for treatment by epilepsy type interactions and making use of direct and indirect evidence. Primary outcomes were time to treatment failure and time to 12 month remission from seizures. A secondary outcome was time to first seizure.ResultsIndividual patient data for 6418 patients from 20 randomised trials comparing eight antiepileptic drugs were synthesized. For partial onset seizures (4628 (72%) patients), lamotrigine, carbamazepine and oxcarbazepine provide the best combination of seizure control and treatment failure. Lamotrigine is clinically superior to all other drugs for treatment failure but estimates suggest a disadvantage compared to carbamazepine for time to 12 month remission [Hazard Ratio (95% Confidence Interval) = 0.87(0.73 to 1.04)] and time to first seizure [1.29(1.13 to 1.48)]. Phenobarbitone may delay time to first seizure [0.77(0.61 to 0.96)] but at the expense of increased treatment failure [1.60(1.22 to 2.10)]. For generalized onset tonic clonic seizures (1790 (28%) patients) estimates suggest valproate or phenytoin may provide the best combination of seizure control and treatment failure but some uncertainty remains about the relative effectiveness of other drugs.ConclusionFor patients with partial onset seizures, results favour carbamazepine, oxcarbazepine and lamotrigine. For generalized onset tonic clonic seizures, results favour valproate and phenytoin.
7 schema:genre article
8 schema:isAccessibleForFree true
9 schema:isPartOf N8591734dd73f4b60971a8ae411fe50ed
10 Nc2ecf2f9a8ba4de9b9e61639f02210fe
11 sg:journal.1297400
12 schema:keywords ConclusionFor patients
13 Cox regression model
14 Secondary outcomes
15 antiepileptic drugs
16 available treatments
17 benefits
18 best combination
19 carbamazepine
20 choice
21 clonic seizures
22 combination
23 comparison
24 control
25 data
26 data evidence
27 decisions
28 disadvantages
29 drugs
30 effectiveness
31 estimates
32 evidence
33 expense
34 failure
35 first seizure
36 generalized onset tonic-clonic seizures
37 harm
38 high-quality evidence
39 indirect evidence
40 individuals
41 interaction
42 lamotrigine
43 major source
44 model
45 monotherapy
46 monotherapy trials
47 months remission
48 multiple treatment comparisons
49 onset seizures
50 onset tonic-clonic seizures
51 outcomes
52 oxcarbazepine
53 partial-onset seizures
54 patient data
55 patients
56 phenobarbitone
57 phenytoin
58 potential benefits
59 primary outcome
60 process
61 quality evidence
62 regression models
63 relative effectiveness
64 remission
65 review
66 seizure control
67 seizures
68 source
69 systematic review
70 time
71 tonic-clonic seizures
72 treatment
73 treatment comparisons
74 treatment failure
75 trials
76 type interaction
77 uncertainty
78 use
79 schema:name Multiple treatment comparisons in epilepsy monotherapy trials
80 schema:pagination 34
81 schema:productId N2d3e7ddaf1344ead9343eb7b13ed372b
82 N48196302fb244abfb7423520026d7c9d
83 N9412b182461a44a5854f0e21103993c5
84 schema:sameAs https://app.dimensions.ai/details/publication/pub.1017847472
85 https://doi.org/10.1186/1745-6215-8-34
86 schema:sdDatePublished 2022-10-01T06:34
87 schema:sdLicense https://scigraph.springernature.com/explorer/license/
88 schema:sdPublisher N35749c72d6f5488284dda246b9d525e7
89 schema:url https://doi.org/10.1186/1745-6215-8-34
90 sgo:license sg:explorer/license/
91 sgo:sdDataset articles
92 rdf:type schema:ScholarlyArticle
93 N2d3e7ddaf1344ead9343eb7b13ed372b schema:name doi
94 schema:value 10.1186/1745-6215-8-34
95 rdf:type schema:PropertyValue
96 N35749c72d6f5488284dda246b9d525e7 schema:name Springer Nature - SN SciGraph project
97 rdf:type schema:Organization
98 N3ecb96eb02724b63bfd4c3ae1ea4a059 rdf:first sg:person.01261374732.97
99 rdf:rest N80f0f4957b56403dae5ca71684f8f183
100 N48196302fb244abfb7423520026d7c9d schema:name dimensions_id
101 schema:value pub.1017847472
102 rdf:type schema:PropertyValue
103 N4d6e07681e914373b4f6dce117289c49 rdf:first sg:person.0710312561.45
104 rdf:rest Nb7a61ae1a2754056b6441882081ad573
105 N80f0f4957b56403dae5ca71684f8f183 rdf:first sg:person.01174075734.81
106 rdf:rest N4d6e07681e914373b4f6dce117289c49
107 N8591734dd73f4b60971a8ae411fe50ed schema:volumeNumber 8
108 rdf:type schema:PublicationVolume
109 N9412b182461a44a5854f0e21103993c5 schema:name pubmed_id
110 schema:value 17983480
111 rdf:type schema:PropertyValue
112 Nb7a61ae1a2754056b6441882081ad573 rdf:first sg:person.01002370610.91
113 rdf:rest rdf:nil
114 Nc2ecf2f9a8ba4de9b9e61639f02210fe schema:issueNumber 1
115 rdf:type schema:PublicationIssue
116 anzsrc-for:11 schema:inDefinedTermSet anzsrc-for:
117 schema:name Medical and Health Sciences
118 rdf:type schema:DefinedTerm
119 anzsrc-for:1109 schema:inDefinedTermSet anzsrc-for:
120 schema:name Neurosciences
121 rdf:type schema:DefinedTerm
122 sg:journal.1297400 schema:issn 1468-6708
123 1745-6215
124 schema:name Trials
125 schema:publisher Springer Nature
126 rdf:type schema:Periodical
127 sg:person.01002370610.91 schema:affiliation grid-institutes:grid.10025.36
128 schema:familyName Williamson
129 schema:givenName Paula R
130 schema:sameAs https://app.dimensions.ai/discover/publication?and_facet_researcher=ur.01002370610.91
131 rdf:type schema:Person
132 sg:person.01174075734.81 schema:affiliation grid-institutes:grid.10025.36
133 schema:familyName Marson
134 schema:givenName Anthony G
135 schema:sameAs https://app.dimensions.ai/discover/publication?and_facet_researcher=ur.01174075734.81
136 rdf:type schema:Person
137 sg:person.01261374732.97 schema:affiliation grid-institutes:grid.10025.36
138 schema:familyName Tudur Smith
139 schema:givenName Catrin
140 schema:sameAs https://app.dimensions.ai/discover/publication?and_facet_researcher=ur.01261374732.97
141 rdf:type schema:Person
142 sg:person.0710312561.45 schema:affiliation grid-institutes:grid.10025.36
143 schema:familyName Chadwick
144 schema:givenName David W
145 schema:sameAs https://app.dimensions.ai/discover/publication?and_facet_researcher=ur.0710312561.45
146 rdf:type schema:Person
147 grid-institutes:grid.10025.36 schema:alternateName Centre for Medical Statististcs and Health Evaluation, University of Liverpool, Liverpool, UK
148 Division of Neuroscience, University of Liverpool, Liverpool, UK
149 schema:name Centre for Medical Statististcs and Health Evaluation, University of Liverpool, Liverpool, UK
150 Division of Neuroscience, University of Liverpool, Liverpool, UK
151 rdf:type schema:Organization
 




Preview window. Press ESC to close (or click here)


...