Choosing a first drug treatment for epilepsy after SANAD: randomized controlled trials, systematic reviews, guidelines and treating patients.
The ILAE treatment guidelines for initial monotherapy emphasise the poor quality of information available to inform everyday clinical practice. Industry sponsored studies comparing antiepileptic drugs answer restricted licensing questions, rather than those relevant to the clinical community (patients, health professionals and founders of health care). The SANAD study, a pragmatic randomized clinical trial, offers a methodology to address some of these questions. It identifies lamotrigine as a cost-effective alternative to carbamazepine for the treatment of focal epilepsies, but confirms valproate as the most effective drug for the treatment of generalized or unclassified epilepsy.
Chadwick
David
D
School of Clinical Science, University of Liverpool, Liverpool, United Kingdom. d.w.chadwick@liverpool.ac.uk
Marson
Tony
T
D000927:Anticonvulsants / Q000191:economics / Q000627:therapeutic use*; D002220:Carbamazepine / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004345:Drug Industry / Q000191:economics / Q000706:statistics & numerical data; D004828:Epilepsies, Partial / Q000188:drug therapy; D004827:Epilepsy / Q000188:drug therapy*; D004829:Epilepsy, Generalized / Q000188:drug therapy; D006801:Humans; D000077213:Lamotrigine; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic / Q000191:economics / Q000706:statistics & numerical data; D012109:Research Support as Topic / Q000191:economics; D016896:Treatment Outcome; D014227:Triazines / Q000191:economics / Q000627:therapeutic use
D000927:Anticonvulsants; D014227:Triazines; D002220:Carbamazepine; D000077213:Lamotrigine