Comment: The quality of evidence is downgraded by imprecise results (few trials in comparisons)
A Cochrane review [Abstract] 1 included 6 studies with a total of 1638 subjects. Five studies were conducted with patients having a manic or mixed episode, and one study with a depressive phase. Topiramate was compared with placebo and other treatment as both monotherapy and as adjunctive treatment.Topiramate was no more efficacious than placebo as monotherapy in terms of mean change on Young Mania Rating Scale (YMRS) (range 0 to 60) at 3 weeks (MD 1.17, 95% CI -0.52 to 2.86; 3 studies, n = 664) and at 12 weeks (MD -0.58, 95% CI -3.45 to 2.29; one study, n = 212). For the same outcome, topiramate was no more efficacious than placebo as add-on therapy at 12 weeks (MD -0.14, 95% CI -2.10 to 1.82; one study, n = 287) in the treatment of manic and mixed episodes. Lithium was more efficacious than topiramate as monotherapy in the treatment of manic and mixed episodes in terms of mean change on YMRS at 12 weeks (MD 8.46, 95% CI 5.86 to 11.06; 2 studies, n = 449).For side effects, there was no difference between topiramate and placebo as monotherapy at 12 weeks (OR 0.68, 95% CI 0.33 to 1.40; one study, n = 212) or as add-on therapy at 12 weeks (OR 1.10, 95% CI 0.58 to 2.10; one study, n = 287). In terms of side effects there was no difference between topiramate and an alternative drug as monotherapy at 12 weeks (OR 0.87, 95% CI 0.50 to 1.52; one study, n = 230) or as add-on therapy at 8 weeks (OR 1.57, 95% CI 0.42 to 5.90; one study, n = 36).
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