Alle Antiseizure-Medikamente zeigten signifikant höhere Ansprechquoten als Placebo; Rufinamid, Cannabidiol und Topiramat hatten die höchste Wahrscheinlichkeit einer mindestens 50%igen Reduktion der Drop-Anfälle, unterschieden sich aber nicht signifikant voneinander. Allerdings führten Cannabidiol, Topiramat und Rufinamid häufiger zu Abbrüchen, mit Cannabidiol signifikant höher als Placebo, Clobazam und Lamotrigin.
Zusammenfassung
NMA über k=8 RCTs (n=1.171) bei Lennox-Gastaut-Syndrom (LGS); verglichene Antikonvulsiva: Lamotrigin, Rufinamid, Cannabidiol, Topiramat, Clobazam, Felbamam. SUCRA-Ranking: Rufinamid und Cannabidiol mit höchster Wahrscheinlichkeit für ≥50%-Anfallsfrequenzreduktion bei Drop-Seizures; kein signifikanter Unterschied zwischen Treatments untereinander. Cannabidiol vs. Placebo, Clobazam und Lamotrigin: signifikant höhere Abbruchrate (p<0.05).
P
PopulationPatienten mit Lennox-Gastaut-Syndrom (LGS), gepoolt n=1171
KontrollePlacebo oder aktive Komparatoren (Netzwerk-Meta-Analyse)
O
OutcomeRufinamid und Cannabidiol mit höchster Wahrscheinlichkeit für ≥50%-Reduktion der Drop-Seizures (SUCRA); Cannabidiol mit signifikant höherer Abbruchrate vs. Placebo, Clobazam und Lamotrigin; alle ASM signifikant besser als Placebo
Vertrauen in die Evidenz
Sehr niedrigNiedrigModeratHoch
Hoch
Höchste von vier GRADE-Stufen, die Effektschätzung ist sehr verlässlich.
To compare and rank the efficacy and safety of antiseizure medication (ASM) in patients with Lennox-Gastaut syndrome (LGS). We included randomized controlled trials (RCTs) assessing the efficacy of ASM for LGS compared with placebo or with each other. The efficacy and safety were reported in terms of an at least 50% monthly seizure frequency reduction in drop seizures, dropout, and serious adverse events. Outcomes were ranked according to the surface under the cumulative ranking curve (SUCRA). A total of eight RCTs with 1171 patients were included, involving six ASMs: lamotrigine, rufinamide, cannabidiol, topiramate, clobazam, and felbamate. The calculated SUCRA showed that rufinamide, cannabidiol, and topiramate had the highest probability of achieving a response; however, no significant differences were found among these treatments. Cannabidiol, topiramate, and rufinamide were more likely to result in dropouts; moreover, a significantly greater percentage of patients receiving cannabidiol experienced premature discontinuation as compared to placebo, clobazam, and lamotrigine. All ASMs showed a significantly higher response rate than placebo. SUCRA ranking demonstrated that rufinamide and cannabidiol are more efficacious than other treatments in reducing drop seizures. However, there was no significant difference between these treatments.