The efficacy and safety of retigabine and other adjunctive treatments for refractory partial epilepsy: a systematic review and indirect comparison.

Abstract

INTRODUCTION:

Retigabine (RTG) is now approved in Europe and the US for the adjunctive treatment of partial-onset seizures in adults with epilepsy. To support submissions to EU reimbursement authorities, we explored its efficacy and tolerability relative to selected antiepileptic drugs (AEDs).

METHODS:

A systematic review was conducted to identify placebo-controlled trials of RTG and selected AEDs approved for use in a similar position in the management pathway of partial epilepsy (eslicarbazepine acetate [ESL], lacosamide [LCM], pregabalin [PGB], tiagabine [TGB] and zonisamide [ZNS]). Using conventional and network meta-analyses as appropriate, we report efficacy and tolerability outcomes for each AED versus placebo and the performance of RTG relative to other AEDs.

RESULTS:

Twenty studies met the inclusion criteria: three each for RTG, ESL, LCM, TGB and ZNS; five for PGB. Comparisons comprised 1-5 studies per AED. In the network meta-analysis, RTG was not found to be different from the other AEDs for responder rate (maintenance period), seizure freedom (maintenance period and double-blind period), withdrawals due to adverse events, and incidences of ataxia, dizziness, fatigue and nausea. Differences between RTG and other AEDs were found for a few comparisons, which did not reveal any trends: RTG was associated with a lower responder rate than PGB during the double-blind period, higher withdrawal rate due to any reason than ESL and a higher incidence of somnolence than TGB.

CONCLUSIONS:

Findings suggest that the risk/benefit for RTG is similar to that for comparator AEDs. However, results should be interpreted in the context of the limitations of the analyses.

• Authors: Marrissa Martyn-St James, Julie Glanville, Rachael McCool, Steve Duffy, James Cooper, Pierre Hugel, Peter W Lane
• Journal: Seizure (Seizure) Vol. 21 Issue 9 Pg. 665-78 (Nov 2012) ISSN: 1532-2688 [Electronic] England
• PMID: 22902288 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't, Review, Systematic Review)
• Copyright: Copyright © 2012 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Anticonvulsants
• Carbamates
• Phenylenediamines
• ezogabine

Topics

• Anticonvulsants (administration & dosage, adverse effects)
• Carbamates (administration & dosage, adverse effects)
• Disorders of Excessive Somnolence (chemically induced, epidemiology)
• Epilepsies, Partial (drug therapy, epidemiology, physiopathology)
• Humans
• Phenylenediamines (administration & dosage, adverse effects)
• Randomized Controlled Trials as Topic (methods)
• Treatment Outcome