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The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial.

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Title: The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial.
Authors: Marson AG (AUTHOR), Al-Kharusi AM (AUTHOR), Alwaidh M (AUTHOR), Appleton R (AUTHOR), Baker GA (AUTHOR), Chadwick DW (AUTHOR), Cramp C (AUTHOR), Cockerell OC (AUTHOR), Cooper PN (AUTHOR), Doughty J (AUTHOR), Eaton B (AUTHOR), Gamble C (AUTHOR), Goulding PJ (AUTHOR), Howell SJL (AUTHOR), Hughes A (AUTHOR), Jackson M (AUTHOR), Jacoby A (AUTHOR), Kellett M (AUTHOR), Lawson GR (AUTHOR), Leach JP (AUTHOR)
Source: Lancet. 3/24/2007, Vol. 369 Issue 9566, p1000-1015. 16p.
Abstract: 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. [ABSTRACT FROM AUTHOR]
Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial.
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  Data: <searchLink fieldCode="AR" term="%22Marson+AG%22">Marson AG</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Al-Kharusi+AM%22">Al-Kharusi AM</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Alwaidh+M%22">Alwaidh M</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Appleton+R%22">Appleton R</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Baker+GA%22">Baker GA</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Chadwick+DW%22">Chadwick DW</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Cramp+C%22">Cramp C</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Cockerell+OC%22">Cockerell OC</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Cooper+PN%22">Cooper PN</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Doughty+J%22">Doughty J</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Eaton+B%22">Eaton B</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Gamble+C%22">Gamble C</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Goulding+PJ%22">Goulding PJ</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Howell+SJL%22">Howell SJL</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Hughes+A%22">Hughes A</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Jackson+M%22">Jackson M</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Jacoby+A%22">Jacoby A</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Kellett+M%22">Kellett M</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Lawson+GR%22">Lawson GR</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Leach+JP%22">Leach JP</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Lancet%22">Lancet</searchLink>. 3/24/2007, Vol. 369 Issue 9566, p1000-1015. 16p.
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  Data: <bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Findings: </bold>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.<bold>Interpretation: </bold>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. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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