Evidence map›Paper›PMID 17382828›Full record

Trial reportLancet (London, England)2007

The SANAD study of effectiveness of valproate, lamotrigine, or topiramate for generalised and unclassifiable 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

Open access · greenAbstract readMulticenter 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. Cited by 247 papers, 23 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
247citing papers in PubMed, 23 pooled it
86.1field-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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

247 citing papers in PubMed, 23 syntheses or guidelines pooled it, 963 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. Pooled it
  11. Pooled it
  12. Pooled it
  13. Pooled it
  14. Pooled it
  15. Pooled it
  16. Pooled it
  17. Pooled it
  18. Pooled it
  19. Pooled it
  20. Pooled it

187 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

backgroundValproate is widely accepted as a drug of first choice for patients with generalised onset seizures, and its broad spectrum of efficacy means it is recommended for patients with seizures that are difficult to classify. Lamotrigine and topiramate are also thought to possess broad spectrum activity. The SANAD study aimed to compare the longer-term effects of these drugs in patients with generalised onset seizures or seizures that are difficult to classify.

methodsSANAD was an unblinded randomised controlled trial in hospital-based outpatient clinics in the UK. Arm B of the study recruited 716 patients for whom valproate was considered to be standard treatment. Patients were randomly assigned to valproate, lamotrigine, or topiramate between Jan 12, 1999, and Aug 31, 2004, and follow-up data were obtained up to Jan 13, 2006. Primary outcomes were time to treatment failure, and time to 1-year remission, and analysis 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, valproate was significantly better than topiramate (hazard ratio 1.57 [95% CI 1.19-2.08]), but there was no significant difference between valproate and lamotrigine (1.25 [0.94-1.68]). For patients with an idiopathic generalised epilepsy, valproate was significantly better than both lamotrigine (1.55 [1.07-2.24] and topiramate (1.89 [1.32-2.70]). For time to 12-month remission valproate was significantly better than lamotrigine overall (0.76 [0.62-0.94]), and for the subgroup with an idiopathic generalised epilepsy 0.68 (0.53-0.89). But there was no significant difference between valproate and topiramate in either the analysis overall or for the subgroup with an idiopathic generalised epilepsy.

interpretationValproate is better tolerated than topiramate and more efficacious than lamotrigine, and should remain the drug of first choice for many patients with generalised and unclassified epilepsies. However, because of known potential adverse effects of valproate during pregnancy, the benefits for seizure control in women of childbearing years should be considered.

Indexed as

Cost-Benefit AnalysisAdolescentAdultAnticonvulsantsChildChild, PreschoolEpilepsy, GeneralizedFemaleFollow-Up StudiesFructoseHumansLamotrigineMaleQuality-Adjusted Life YearsTime FactorsTopiramateAnticonvulsantsFructoseLamotrigineTopiramateTriazinesValproic Acid

Identifiers

PMID17382828
PMCPMC2039891
OpenAlexW2147974822

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

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.