A Cochrane review [Abstract] 1 included 6 studies with a total of 836 patients. The trials recruited both children and adults. For remission outcomes, HR > 1 indicated an advantage for phenobarbitone (PB), and for first seizure and withdrawal outcomes, HR > 1 indicated an advantage for carbamazepine (CBZ).The main overall results (pooled HR adjusted for seizure type, 95% CI) were HR 1.50 for time to withdrawal of allocated treatment (95% CI 1.15 to 1.95, p = 0.003; 4 studies, n=676); HR 0.93 for time to 12-month remission (95% CI 0.72 to 1.20, p= 0.57; 4 studies, n=683); HR 0.99 for time to 6-month remission (95% CI 0.80 to 1.23, p= 0.95; 4 studies, n=683); and HR 0.87 for time to first seizure (95% CI 0.72 to 1.06, p = 0.18; 4 studies, n=822). Results suggest an advantage for CBZ over PB in terms of time to treatment withdrawal and no statistically significant evidence between the drugs for the other outcomes. There was no statistically significant interaction between treatment effect and seizure type for time to first seizure recurrence (p = 0.03), where PB was favoured for partial onset seizures (HR 0.76, 95% CI 0.60 to 0.96, p = 0.02; 6 studies, n=584) and CBZ was favoured for generalised onset seizures (HR 1.23, 95% CI 0.88 to 1.77, p = 0.27; 5 studies, n=238).
Comment: The quality of evidence is downgraded by study quality (lack of or unclear allocation concealment, high drop-out rate) and indirectness (most of the studies conducted in developing countries).
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