Abstracts

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 RCTs have failed to inform a choice among these drugs as they have failed to examine meaningful longer term outcomes., SANAD is an NHS HTA sponsored un-blinded randomized controlled trial. Arm A recruited patients for whom carbamazepine was considered to be standard treatment and were randomized to carbamazepine, gabapentin, lamotrigine, oxcarbazepine, topiramate. Choice of drug dose and changes in it were determined by clinicians[apos] usual practice. Outcomes were time to treatment failure, and time to 1-year remission. Sample size calculations were calculated to detect both equivalence and difference., 378, 377, 377, 210, 378 children and adults were randomized to carbamazepine, gabapentin, lamotrigine, oxcarbazepine and topiramate respectively. 87% of patients were classified as symptomatic or cryptogenic partial epilepsy at randomisation. For time to treatment failure lamotrigine was significantly superior to carbamazepine hazard ratio (HR 95% CI) 0.80 (0.64, 0.99), gabapentin 0.65 (0.52, 0.79), oxcarbazepine 0.76 (0.59, 0.99) and topiramate 0.65 (0.53, 0.80). For time to 12 month remission gabapentin was significantly inferior to carbamazepine 0.75 (0.62, 0.89), lamotrigine 0.82 (0.68, 0.98), oxcarbazepine 0.72 (0.58, 0.90). There was no significant difference between carbamazepine and lamotrigine 1.10 (0.92, 1.30)., Lamotrigine has similar long term efficacy to, and is better tolerated than, carbamazepine. Lamotrigine should now be considered the treatment of first choice for patients with partial onset seizures., (Supported by NHS HTA programme.)