Oxcarbazepine for Acute Affective Episodes in Bipolar Disorder

Summary

A systematic review 1 [Abstract] included 7 studies with a total of 368 subjects. Six studies were conducted in adults. All were on mania, hypomania, mixed episodes or rapid-cycling disorder. Studies compared oxcarbazepine vs. placebo (n=1), haloperidol (n=2), lithium (n=1), valproate (n=2) and carbamazepine (n=1). There was no difference in the primary outcome analysis, a fall of 50% or more on the Young Mania Rating Scale (YMRS), between oxcarbazepine and placebo (OR =2.10, 95% CI 0.94 to 4.73; N=1, n=110) in the study conducted in children; no studies were available in adult participants. In comparison with other mood stabilisers, there was no difference between oxcarbazepine and valproate as an antimanic agent using the primary outcome (OR=0.44, 95% CI 0.10 to 1.97, 1 study, n=60) or the secondary outcome (differences in YMRS between the two groups, SMD=0.18, 95% CI -0.24 to 0.59, 2 studies, n=90). No primary or secondary efficacy outcome measures were found comparing oxcarbazepine with lithium monotherapy.As an adjunctive treatment to lithium, oxcarbazepine reduced depression rating scale scores more than carbamazepine in a group of manic participants on the Montgomery-Åsberg Depression Rating Scale (MADRS) (SMD=- 1.12, 95% CI -1.71 to -0.53, 1 study, n=52) and on the Hamilton Depression Rating Scale (HDRS) (SMD=- 0.77, 95% CI -1.35 to -0.20, 1 study, n=52).There was a higher incidence of adverse effects, particularly neuropsychiatric, in participants randomised to oxcarbazepine compared to those on placebo (17% to 39% of participants on oxcarbazepine had at least one such event compared to 7% to 10% on placebo; 1 study, n=115).There was no difference in adverse events rates between oxcarbazepine and other mood stabilisers or haloperidol.

Comment: The quality of the evidence is downgraded by study quality (inadequate allocation concealment, lack of blinding), inconsistency (heterogeneity in patients and interventions), impreciseness (few studies in each comparison) and indirectness of evidence (differences in studied patients, the only placebo controlled trial conducted with children).