Carisbamate Add-on Therapy For Partial Epilepsy:A Systematic Review

Objective:To evaluate the efficacy and tolerability of carisbamate as an add-on therapy for partial epilepsy.Methods:The randomized controlled trials (RCTs) of carisbamate as an add-on therapy for partial epilepsy were systematically searched in CENTRAL,. Pubmed and Embase until Jan 2015. The risks of bias of the included RCTs were assessed according to the methods recommended by the Cochrane Collaboration. The rate of seizures reduction≥50% responder, seizure freedom, treatment withdrawal and adverse events were extracted. Meta-analysis was performed with RevMan 5.3 software.Results:Three articles involving four trials and 2211 patients were included. The meta-analysis showed that carisbamate was significantly superior to placebo in responder rate (RR= 1.36,95% CI= 1.14-1.62), but no significant difference was found between the two groups in patients with seizure freedom (RR= 2.43,95% CI= 0.84～7.05). During the treatment period, total withdrawals (RR= 1.32,95% CI= 0.82～2.12), withdrawals due to adverse events (RR= 1.80, 95% CI= 0.78～4.17) and patients with at least one adverse event (RR= 1.10, 95% CI= 0.93～1.30) did not show significant difference between carisbamate and placebo. Dizziness (RR= 2.06,95% CI= 1.23～3.44) and somnolence (RR= 1.82,95% CI= 1.28～2.58) were significantly in relation to carisbamate. A subgroup analysis according to different doses of carisbamate indicated that patients in the low-dose group were more likely to achieve 50% seizure reduction or more with well tolerability while the high-dose group was associated with non-significant responder rate and more dropouts due to adverse events.Conclusion:This review showed that carisbamate in short term is effective and safe as add-on therapy for partial epilepsy (especially in lower doses). However, more well-designed randomized, double-blind, placebo-controlled trials with a longer-term duration are needed in the future.