Summary of findings for the main comparison.
Summary of findings ‐ Time to withdrawal of allocated treatment for individuals with partial seizures
| Antiepileptic drug monotherapy for epilepsy: time to withdrawal of allocated treatment for individuals with partial seizures | ||||||
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Patient or population: adults and children with partial seizures Settings: outpatients Intervention: phenobarbitone, phenytoin, sodium valproate, lamotrigine, oxcarbazepine, topiramate, gabapentin, levetiracetam and zonisamide Comparison: carbamazepine | ||||||
|
Intervention (experimental treatment)a,b |
Comparison (reference treatment) |
No of participants (studies) with direct evidence |
Relative effect HR (95% CI) Direct evidence (pairwise meta‐analysis)c Heterogeneity: I2 |
Relative effect HR (95% CI) Direct plus indirect evidence (network meta‐analysis)c |
Proportion of direct evidence (%)d | Quality of the evidence (GRADE) |
| Phenobarbitone | Carbamazepine | 520 (4 studies) |
1.57 (1.16 to 2.13) I2 = 0% |
1.55 (1.18 to 2.04) | 52.5% | ⊕⊕⊕⊕ highe,f |
| Phenytoin | Carbamazepine | 428 (3 studies) |
1.03 (0.74 to 1.42) I2 = 63.6% |
1.13 (0.92 to 1.38) | 12.8% | ⊕⊕⊕⊕ highe,f,g |
| Sodium Valproate | Carbamazepine | 814 (5 studies) |
0.94 (0.73 to 1.19) I2 = 0% |
1.04 (0.86 to 1.25) | 40.1% | ⊕⊕⊕⊕ highe,f |
| Lamotrigine | Carbamazepine | 2268 (9 studies) |
0.76 (0.61 to 0.95) I2 = 39.3% |
0.75 (0.65 to 0.86) | 28.9% | ⊕⊕⊕⊕ highe,f |
| Oxcarbazepine | Carbamazepine | 562 (2 studies) |
4.62 (0.95 to 22.4) I2 = 0% |
1.09 (0.84 to 1.42) | 5.7% | ⊕⊕⊕⊕ highe,f |
| Topiramate | Carbamazepine | 937 (2 studies) |
1.04 (0.52 to 2.07) I2 = 0% |
1.18 (0.98 to 1.43) | 7.4% | ⊕⊕⊕⊕ highe,f |
| Gabapentin | Carbamazepine | 954 (2 studies) |
1.14 (0.84 to 1.55) I2 = 0% |
1.20 (1.00 to 1.43) | 87.1% | ⊕⊕⊕⊕ highe,f |
| Levetiracetam | Carbamazepine | 1567 (3 studies) |
0.70 (0.52 to 0.94) I2 = 0% |
0.82 (0.69 to 0.97) | 37.9% | ⊕⊕⊕⊕ highe,f |
| Zonisamide | Carbamazepine | 583 (1 study) |
1.08 (0.81 to 1.44) I2 = NA) |
1.08 (0.79 to 1.48) | 100% | ⊕⊕⊕⊕ highe,f |
| Abbreviations: CI: confidence interval; HR: hazard ratio; NA: not applicable | ||||||
| GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate. | ||||||
aOrder of drugs in the table: drugs are ordered approximately by the date they were licenced as a monotherapy treatment (oldest first). bHR < 1 indicates an advantage to the experimental treatment cHRs and 95% CIs are calculated from fixed‐effect analyses (pairwise and network meta‐analysis). dProportion of the estimate contributed by direct evidence. eSeveral trials contributing direct evidence or contributing to the network meta‐analysis were at high risk of bias for at least one domain (see Risk of bias in included studies); we performed numerous sensitivity analyses in the case of particular sources of bias or inconsistencies within individual participant data provided to us (see Sensitivity analysis for full details). Results of sensitivity analyses showed similar numerical results and no changes to conclusions, therefore we judged that any risks of bias within the trials included in these analyses have not influenced the overall results (no downgrade of quality of evidence). fNo indication of inconsistency between direct evidence and network meta‐analysis results (no downgrade of quality of evidence). gLarge amount of heterogeneity present in pairwise meta‐analysis; no change to conclusions when analysis was repeated with random‐effects, and heterogeneity likely due to difference in trial designs (e.g. age of participants). Despite heterogeneity, numerical results from direct evidence and from network results are similar and conclusions the same (no downgrade of quality of evidence).