Evidence map›Paper›PMID 17382827›Full record

Trial reportLancet (London, England)2007

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

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 and 20 more

Registry-linked trialOpen access · greenAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Lancet (London, England), 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05450822 (The BrainDrugs-Epilepsy Study), which is not on this map. Cited by 237 papers, 24 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
237citing papers in PubMed, 24 pooled it
33.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05450822 recruitingnot on this mapstarted 2022, after this paper: background citation

The BrainDrugs-Epilepsy Study: A Prospective Open-label Cohort Precision Medicine Study in Epilepsy

TypeobservationalSponsorGitte Moos KnudsenRan2022 to 2031Enrolled550ConditionsEpilepsyArmsLevetiracetam, Levetiracetam Tablets, Lamotrigine tablet
3 · Its place in the literature

Who cites it

237 citing papers in PubMed, 24 syntheses or guidelines pooled it, 972 citations in OpenAlex.

  1. Pooled it
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  7. Zonisamide add-on therapy for focal epilepsy.The Cochrane database of systematic reviews · 2020
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  9. Genetic testing for prevention of severe drug-induced skin rash.The Cochrane database of systematic reviews · 2019
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  11. Zonisamide add-on therapy for focal epilepsy.The Cochrane database of systematic reviews · 2018
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177 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

30 authors at 17 institutions in 1 country.

Anthony G MarsonDivision of Neurological Science, University of Liverpool, UK. a.g.marson@liv.ac.uk
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
SANAD Study group
University of Liverpool · GBNewcastle University · GBRoyal Bolton Hospital · GBAlder Hey Children's NHS Foundation Trust · GBArrowe Park Hospital · GBGreat Ormond Street Hospital · GBLeeds General Infirmary · GBNinewells Hospital · GBRoyal Hallamshire Hospital · GBRoyal London Hospital · GBRoyal Shrewsbury Hospital · GBRoyal Victoria Infirmary · GBSouthern General Hospital · GBSouthport and Formby District General Hospital · GBSunderland Royal Hospital · GBUniversity Hospital of Wales · GBWhiston Hospital · GB

Funding

Department of Health HTA_485Department of Health HTA/95/13/01Wellcome Trust
6 · The paper itself

Abstract

backgroundCarbamazepine 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.

methodsSANAD 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.

findingsFor 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.

interpretationLamotrigine 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.

Indexed as

Quality of LifeAdolescentAdultAnticonvulsantsChildCost-Benefit AnalysisEpilepsies, PartialFemaleHumansMaleTreatment OutcomeAnticonvulsants

Identifiers

PMID17382827
PMCPMC2080688
OpenAlexW2138521331

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.