Document Detail

The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial.
MedLine Citation:
PMID:  17382827     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Carbamazepine is widely accepted as a drug of first choice for patients with partial onset seizures. Several newer drugs possess efficacy against these seizure types but previous randomised controlled trials have failed to inform a choice between these drugs. We aimed to assess efficacy with regards to longer-term outcomes, quality of life, and health economic outcomes.
METHODS: SANAD was an unblinded randomised controlled trial in hospital-based outpatient clinics in the UK. Arm A recruited 1721 patients for whom carbamazepine was deemed to be standard treatment, and they were randomly assigned to receive carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate. Primary outcomes were time to treatment failure, and time to 12-months remission, and assessment was by both intention to treat and per protocol. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN38354748.
FINDINGS: For time to treatment failure, lamotrigine was significantly better than carbamazepine (hazard ratio [HR] 0.78 [95% CI 0.63-0.97]), gabapentin (0.65 [0.52-0.80]), and topiramate (0.64 [0.52-0.79]), and had a non-significant advantage compared with oxcarbazepine (1.15 [0.86-1.54]). For time to 12-month remission carbamazepine was significantly better than gabapentin (0.75 [0.63-0.90]), and estimates suggest a non-significant advantage for carbamazepine against lamotrigine (0.91 [0.77-1.09]), topiramate (0.86 [0.72-1.03]), and oxcarbazepine (0.92 [0.73-1.18]). In a per-protocol analysis, at 2 and 4 years the difference (95% CI) in the proportion achieving a 12-month remission (lamotrigine-carbamazepine) is 0 (-8 to 7) and 5 (-3 to 12), suggesting non-inferiority of lamotrigine compared with carbamazepine.
INTERPRETATION: Lamotrigine is clinically better than carbamazepine, the standard drug treatment, for time to treatment failure outcomes and is therefore a cost-effective alternative for patients diagnosed with partial onset seizures.
Anthony G Marson; Asya M Al-Kharusi; Muna Alwaidh; Richard Appleton; Gus A Baker; David W Chadwick; Celia Cramp; Oliver C Cockerell; Paul N Cooper; Julie Doughty; Barbara Eaton; Carrol Gamble; Peter J Goulding; Stephen J L Howell; Adrian Hughes; Margaret Jackson; Ann Jacoby; Mark Kellett; Geoffrey R Lawson; John Paul Leach; Paola Nicolaides; Richard Roberts; Phil Shackley; Jing Shen; David F Smith; Philip E M Smith; Catrin Tudur Smith; Alessandra Vanoli; Paula R Williamson;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Lancet     Volume:  369     ISSN:  1474-547X     ISO Abbreviation:  Lancet     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-03-26     Completed Date:  2007-04-05     Revised Date:  2014-06-20    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  England    
Other Details:
Languages:  eng     Pagination:  1000-15     Citation Subset:  AIM; IM    
Data Bank Information
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MeSH Terms
Anticonvulsants / adverse effects,  economics,  therapeutic use*
Cost-Benefit Analysis
Epilepsies, Partial / classification,  drug therapy*
Quality of Life*
Treatment Outcome
Grant Support
HTA/95/13/01//Department of Health; HTA_485//Department of Health
Reg. No./Substance:
Comment In:
Epilepsy Curr. 2007 Sep-Oct;7(5):125-7   [PMID:  17998970 ]
Rev Neurol Dis. 2008 Winter;5(1):36-7   [PMID:  18418324 ]
ACP J Club. 2007 Nov-Dec;147(3):74-5   [PMID:  17975876 ]
Lancet. 2007 Jul 28;370(9584):314-5; author reply 315-6   [PMID:  17662872 ]
Lancet. 2007 Jul 28;370(9584):314; author reply 315-6   [PMID:  17662871 ]
Lancet. 2007 Jul 28;370(9584):313-4; author reply 315-6   [PMID:  17662869 ]
Nat Clin Pract Neurol. 2007 Sep;3(9):484-5   [PMID:  17622230 ]
Lancet. 2007 Mar 24;369(9566):970-1   [PMID:  17382806 ]
Lancet. 2007 Jul 28;370(9584):313; author reply 315-6   [PMID:  17662870 ]

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