Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang, 325005, China.
Department of Psychiatry, Tianjin Anding Hospital, Tianjin, 300222, China.
Sci Rep. 2017 May 31;7(1):2535. doi: 10.1038/s41598-017-02525-2.
This study was proposed to compare the relative efficacy and tolerability of the second and third generation AEDs for refractory epilepsy. The 50% responder rate (RR) was selected as the efficacy outcome whereas the incidence of dizziness and somnolence were considered to evaluate the tolerability of AEDs. Odds ratio (OR) and their 95% credible interval (CrI) were obtained using a consistency model and surface under the cumulative ranking curve (SUCRA) value was calculated to rank AEDs. Topiramate appeared to be significantly more effective than placebo, eslicarbazepine acetate, perampanel, pregabalin, zonisamide, gabapentin and lamotrigine with respect to the 50% RR (all OR > 1). Patients who were managed by eslicarbazepine acetate, perampanel, oxcarbazepine, topiramate and pregabalin were more likely to suffer from dizziness compared to those who receive placebo (all OR > 1). Perampanel, topiramate and pregabalin were related to elevated risks of somnolence compared to placebo (all OR > 1). Moreover, topiramate ranked highest with respect to 50% RR (SUCRA = 0.968) whereas levetiracetam appeared to have balanced efficacy and tolerability (SUCRA = 0.769, 0.743, 0.604 and 0.659). In conclusion, topiramate was the most efficacious AED, while levetiracetam was able to provide patients with balanced efficacy and tolerability.
本研究旨在比较第二代和第三代抗癫痫药物治疗耐药性癫痫的相对疗效和耐受性。50%应答率（RR）被选为疗效结局，而头晕和嗜睡的发生率则被认为是评估 AED 耐受性的指标。采用一致性模型获得比值比（OR）及其 95%可信区间（CrI），并计算累积排序曲线下面积（SUCRA）值来对 AED 进行排序。与安慰剂相比，托吡酯在 50%RR 方面似乎明显更有效（所有 OR>1）。与接受安慰剂的患者相比，接受乙琥胺、吡仑帕奈、奥卡西平、托吡酯和普瑞巴林治疗的患者更有可能出现头晕（所有 OR>1）。与安慰剂相比，吡仑帕奈、托吡酯和普瑞巴林与嗜睡风险增加相关（所有 OR>1）。此外，托吡酯在 50%RR 方面排名最高（SUCRA=0.968），而左乙拉西坦似乎具有平衡的疗效和耐受性（SUCRA=0.769、0.743、0.604 和 0.659）。总之，托吡酯是最有效的 AED，而左乙拉西坦能够为患者提供平衡的疗效和耐受性。
