SANAD study brings new insights into epilepsy treatment

epilepsy is a common disease worldwide, with 70% of patients receiving long-term remission within a short period of time after starting medicationCurrently, kamapineispin is recommended as the preferred medication for some patients with seizures with epilepsyOver the past 15 years, a new generation of anti-epileptic drugs has been introduced and marketed, such as egabin, gabadine and remacemiaHowever, current trials have shown that these drugs are less effective than carmasilin, and there is no need to further investigate whether they may be used as a first-line drugRandomized controlled trials of gabathatin, lamotine, ocasipin and toadvanceestin showed that their single drug treatment spent effective, but for some reason these results did not inform clinical practice or policy developmentTo this end, the researchers conducted a newstandardof lamotine substitute kamamipine as a partial seizure treatment for epilepsy, sANAD research, which adopted an open, randomized and controlled approach to compare the differences betweenstandardtreatment and the new generation of anti-epileptic drugs in epilepsy control, tolerance, quality of life and health economicsThe results of Group A in the SANAD study are described belowRandomized controlled studies of five drugsif the patient had two or more clinically explicit non-induced seizures in the past year, and the clinician determined that kamamipin was a betterstandardtreatment option than sodium valproate, then group A of SANAD studiesThe criteria for admission also include: newly diagnosed epilepsy patients, patients with epilepsy who failed the treatment alone (as long as the treatment failed drug is not a randomly grouped drug), epileptic patients who had had remission but then relapsed after withdrawalExclusion criteria include: clinicians believe that there is a treatment contraindication, all eclampsia is acute symptomatic episodes (including high fever convulsions), age of 4 years, progressive nervous system disease The participants were treated with carbamazepine, gabathin, lamothine, ocasipin and toterinats at random according to a ratio of 1:1:1:1 The purpose of treatment is to effectively control epilepsy with the lowest dose of the drug Patients must be followed up for 3, 6 and 12 months after admission, followed by 1 visit in the following year The main endpoints of the study were twothings: from randomization to the time of treatment failure, from randomization to one year of epilepsy relief Secondary endpoints include: time from randomization to first seizure, time of 2 years of remission, clinically significant adverse events and the incidence of adverse reactions after randomization The initial analysis of survival data is based on timing testing and Cox scale risk models Intentional therapy analysis and completion of treatment analysis were used for the main clinical endpoint The advantages of the five drugs were compared from December 1, 1999 to August 31, 2004, when randomization ended, with a total of 1721 patients included: 378 cases in the camacipine group, 377 cases in the Gababadin group, 378 cases in the Lamotine group, 210 cases in the Occispin group and 378 cases in the Topidine group Eighty-eight percent of patients had cryptogenic or symptomatic partial seizures and 10 percent had unclassified epilepsy Eventually, 49 patients were excluded from various analyses Group A trialcompleted 94% of patient follow-up (follow-up 5406 patient years) and expected to complete 5462 patient years Of the 71 deaths, 10 were related to epilepsy, 1 case in the Kamaxiflat group, 2 cases in the gabathadine group, 4 cases in the Lamotine group, 3 cases in the Osipin group, none in the toterin group The remaining 61 patients died from other causes There were significant differences in the duration of treatment failures between drugs, and a pairing analysis throughout the trial found that lamotrigine was better than all other drugs, with gabatin and toterine performing worst The reasons for the failure of treatment varied from group to group: the karmaride and tothestine groups were the most likely to fail due to adverse events, while the lamotrigine and gabapentin groups were the least likely; These results support the efficacy of lamotriginine no less than carmasilin The analysis of Ocaspin, which began with patient admission on June 1, 2001, showed that Theoverally and Kapasimin had similar treatment failure rates, and that Ocaspin adverse reactions may have less than Camasipine, but Okasipine was also more likely to fail due to poor epilepsy control These performances do not seem to support the idea that Ocasipine is no less effective than Kamacipine There was a significant difference between drugs and 12 months of epilepsy relief, with gabapentin and tores being the two least desirable treatments Not only does gabathinetine has significant differences from Kamaxipine, but there are also significant differences compared to Lamotine and Ocasipine The intentional treatment analysis included follow-up data after the failure of treatment, a new drug failed (excluding ocasipine), and the replacement of carmasilin can be eased However, if the treatment of carbamazepine fails again, the switch to lamotrigine can often regain remission The difference between camazepin and lamotrigine appeared to be small throughout the treatment period, and although lamotrigine had a 4% effect in the first year, there was no significant difference by the second year, and the effect was better in 4 to 5 years These results show that lamotrigine is no less than carmapine in terms of the main therapeutic endpoint About 50 percent of patients reported adverse events during the study, but there was little difference between the drugs In the intentional treatment population, lamotrigine was the drug with the lowest number of adverse events reported, while topropidainwas was the most common Weakness, headache, and weakness are the most common individual symptoms, but this is not specific to the drug Depression, memory disorders, and various mental symptoms are common, especially in the toterilate group Rashes are common non-central nervous system symptoms, with camazepin and ocasipin groups more common, and the incidence of ramotriquine rashes slightly lower Overall, the most common adverse events associated with treatment failure were rashes: camazepine, ocasipin and lamotrigine, respectively, had a rash incidence of 7%, 6% and 3%, respectively The quality of life analysis showed that there was little significant difference in the quality of life of patients in the two-year treatment group, and that tothinestine reduced the incidence of anxiety in patients compared to cababuta, but was not significant compared to lamotrigine and ocasipin Compared with other anti-epileptic drugs, lamotrigine can effectively reduce the risk of depression, which is significantly different from gabapentin Two cost analyses for each life quality adjustment year (QALY) were compared with carmasilin, gabathin, lamotine, and topisterandands, and carmasilin, gabatin, lamotine, ocasipin and Totitin The first analysis showed that kamasi pin and lamotrigine had the lowest estimates, and the second analysis showed that the increase in the cost of gabapentin and the decrease in QALY, therefore, lamotrigine was more cost-benefit-than-benefit ratio and had an advantage The new standard of treatment for patients with epilepsy who require single-drug treatment, lamotrigine is significantly better than the previous standard treatment (carmapine) and the next generation of anti-epileptic drugs gabapentin and tothestine By 12 months of epilepsy relief time, lamotrigine was no less than carmasilin The study is non-blind, and the state is closer to clinical practice, thus greatly reducing the cost of the study and thus improving its feasibility To address certain concerns such as interactions with other drugs during treatment, treatment of women during childbirth, dose stake or dosage form, the researchers randomly selected 1,721 patients and followed them up for a long time, which was not possible in a small-scale clinical trial SANAD is the only large drug comparison trial, including quality of life, health economy and clinical evaluation Consistent with previous studies, respondents may have better results and better current states than those who do not Analysis of the main clinical results showed that the treatment failure rate of lamotrigine was the lowest and significantly different compared to other anti-epileptic drugs (except ocasipine), and there was no significant difference between the time and tolerance of the remission to 12 months, i.e the results of lamotrigine were no less than carmasilin in these areas Given that the patient may be receiving other medications at the same time, the tolerance of lamotrigine is better than carmasilin, and the long-term effect is not inferior to carmasilin, so most patients with epilepsy are preferred for lamotrigine treatment Economic analysis showed that lamotrigine was superior to carbamazepine in preventing each seizure and the cost of each QALY In terms of cost-benefit, lamotrigine is better than camaxiin (Ding Ting)