Largest Trial Of Epilepsy Drugs Publishes Findings, UK

Main Category: Epilepsy
Also Included In: Clinical Trials / Drug Trials
Article Date: 17 Oct 2007 - 1:00 PDT

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A ground breaking trial of drug treatments for epilepsy has published its full results. The findings of the trial, commissioned by the National Institute for Health Research's Health Technology Assessment (NIHR HTA) programme, suggest that a newer drug, lamotrigine is clinically superior to the existing drug of first choice for the treatment of partial epilepsy, while an older drug, valproate is better than new for treatment of generalised seizures. Epilepsy is a common disorder affecting up to 1% of the population. It impacts significantly upon the quality of life of patients, but as many as 70% of patients enter long term remission shortly after starting drug therapy.

More than 2,000 patients took part in the multi-centre SANAD trial, the largest trial of its kind, led by Professor David Chadwick of the University of Liverpool. The research compared newer drugs for epilepsy with carbamazepine and valproate, which have been widely accepted as the drugs of first choice for patients with partial onset and generalised seizures respectively for the last 20 years. Researchers found that the newer, lamotrigine, is clinically superior and is a cost-effective alternative to carbamazepine for the majority of patients diagnosed with partial seizures. However valproate remains the most clinically effective drug for patients with generalised epilepsy.

"Despite the lack of research evidence there has been a steady rise in the prescribing of newer antiepileptic drugs in recent years. In 2002 new drugs accounted for 69% of the total costs of antiepileptic drugs to the NHS (£99 million of £142 million) so it was vital that research was conducted to allow doctors to make informed decisions about the best first line treatment to use before newer, more expensive drugs became the first choice by default," says Professor Chadwick.

"Its size and its NHS setting mean that the results of SANAD are highly relevant to clinical practice, allowing doctors and patients to make more informed decisions about what drugs to prescribe and take, and translating directly into benefit for patients."

Published in Health Technology Assessment Journal Series Vol.11.37. To view and download the full report visit here.

1.In patients with partial epilepsy, carbamazepine was compared to newer drugs gabapentin, lamotrigine and oxcarbazepine and topiramate. In generalised epilepsy, valproate was compared with lamotrigine and topiramate.

2.The study involved patients (both children above the age of five and adults) who had had two or more clinically definite unprovoked epileptic seizures within the past year, and for whom treatment with a single antiepileptic drug was the best option.

3.The findings of the trial have published in the Lancet Volume 369, number 9566, please click here.

4.The HTA programme is a programme of the National Institute for Health Research (NIHR) and produces high quality research information about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest of the NIHR programmes and publishes the results of its research in the Health Technology Assessment journal, with almost 400 issues published to date. The journal's 2006 Impact Factor (5.29) ranked it in the top 10% of medical and health-related journals. All issues are available for download free of charge from the website, http://www.hta.ac.uk The HTA programme is coordinated by the National Coordinating Centre for Health Technology Assessment (NCCHTA), based at the University of Southampton.

5. The National Institute for Health Research provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients. http://www.nihr.ac.uk

University of Southampton