Factors determining response to antiepileptic drugs in randomized controlled trials. A systematic review and meta-analysis

Détails

ID Serval
serval:BIB_14FF8D7A138F
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Factors determining response to antiepileptic drugs in randomized controlled trials. A systematic review and meta-analysis
Périodique
Epilepsia
Auteur⸱e⸱s
Rheims S., Perucca E., Cucherat M., Ryvlin P.
ISSN
1528-1167 (Electronic)
ISSN-L
0013-9580
Statut éditorial
Publié
Date de publication
02/2011
Volume
52
Numéro
2
Pages
219-33
Langue
anglais
Notes
Rheims, Sylvain
Perucca, Emilio
Cucherat, Michel
Ryvlin, Philippe
eng
Meta-Analysis
Review
Epilepsia. 2011 Feb;52(2):219-33. doi: 10.1111/j.1528-1167.2010.02915.x. Epub 2011 Jan 26.
Résumé
PURPOSE: Because of the lack of head-to-head adjunctive-therapy trials of antiepileptic drugs (AEDs) in refractory partial epilepsy, meta-analyses of placebo-controlled randomized controlled trials (RCTs) represent a potentially important source of evidence to guide treatment decisions. However, such indirect comparisons raise various methodologic issues that may hamper their relevance. METHODS: All RCTs in adult refractory partial epilepsy were analyzed to assess whether efficacy outcomes are influenced by: characteristics of patients and trials ; use of last observation carried forward (LOCF) analysis; evaluation period (entire period versus maintenance period); and year of publication. A meta-analysis of these AEDs was then performed taking these factors into consideration. KEY FINDINGS: Sixty-three RCTs evaluating 20 AEDs were included. The following variables influenced efficacy estimates: (1) responder rates correlated positively with duration of the entire treatment period (p = 0.038); (2) response to placebo was significantly greater in the maintenance period than in the entire treatment period (p = 0.005); (3) responder rates increased over the years both for AEDs (p < 0.001) and for placebo (p = 0.001); (4) LOCF analysis overestimated responder rates for AEDs (p < 0.001) and for placebo (p = 0.001) compared with completer-based analysis, and the overestimation correlated positively with withdrawal rates (p < 0.001). A meta-analysis of available data showed large differences in efficacy ranking in relation to dose selection and type of analysis, but these were mostly nonsignificant due to statistical power limitations. SIGNIFICANCE: Several methodologic issues hamper the relevance of indirect comparisons of AEDs in the adjunctive-therapy of refractory partial epilepsy. Some of these issues could be overcome by improved standardization in the reporting of efficacy outcomes.
Mots-clé
Adult, Anticonvulsants/*therapeutic use, Data Interpretation, Statistical, Dose-Response Relationship, Drug, Drug Resistance, Endpoint Determination, Epilepsies, Partial/drug therapy, Epilepsy/*drug therapy, Humans, Placebos, Randomized Controlled Trials as Topic, Research Design, Treatment Outcome
Pubmed
Open Access
Oui
Création de la notice
29/11/2018 12:37
Dernière modification de la notice
20/08/2019 12:43
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