Cochrane · systematic review · CD001769
Sodium valproate versus phenytoin monotherapy for epilepsy: an individual participant data review
Nevitt, SJ, Marson, AG, Weston, J, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
9
current version
GRADE rated
9
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 0 · 0%Low 4 · 44.4%Moderate 5 · 55.6%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlySodium valproate compared with phenytoin monotherapy for epilepsy (primary outcome)
Population: adults and children with newly‐onset focal onset or generalised tonic‐clonic seizures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Time to treatment failure (any reason related to treatment) All participants Range of Sodium valproate vs phenytoin monotherapy | HR 0.88 [0.61, 1.27] | 5 studies · 528 participants | Moderate Downgraded: risk of bias |
Time to treatment failure (any reason related to treatment) Subgroup: focal onset seizures Range of Sodium valproate vs phenytoin monotherapy | HR 0.83 [0.5, 1.38] | 4 studies · 187 participants | Moderate Downgraded: risk of bias |
Time to treatment failure (any reason related to treatment) Subgroup: generalised onset seizures (tonic‐clonic only) Range of Sodium valproate vs phenytoin monotherapy | HR 0.94 [0.55, 1.61] | 5 studies · 341 participants | Low Downgraded: risk of bias, inconsistency |
Sodium valproate compared with phenytoin monotherapy for epilepsy (secondary outcomes)
Population: adults and children with newly‐onset focal onset or generalised tonic‐clonic seizures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Time to first seizure (post‐randomisation) All participants Range of Sodium valproate vs phenytoin monotherapy | HR 1.08 [0.88, 1.33] | 5 studies · 639 participants | Low Downgraded: risk of bias, indirectness |
Time to first seizure (post‐randomisation) Subgroup: focal onset seizures Range of Sodium valproate vs phenytoin monotherapy | HR 1.2 [0.9, 1.6] | 4 studies · 244 participants | Low Downgraded: risk of bias, indirectness |
Time to first seizure (post‐randomisation) Subgroup: generalised onset seizures (tonic‐clonic only) Range of Sodium valproate vs phenytoin monotherapy | HR 0.97 [0.72, 1.3] | 5 studies · 395 participants | Low Downgraded: risk of bias, indirectness |
Time to achieve 12‐month remission (seizure‐free period) All participants Range of Sodium valproate vs phenytoin monotherapy | HR 1.02 [0.81, 1.28] | 4 studies · 514 participants | Moderate Downgraded: risk of bias |
Time to achieve 12‐month remission (seizure‐free period) Subgroup: focal onset seizures Range of Sodium valproate vs phenytoin monotherapy | HR 1.11 [0.78, 1.6] | 4 studies · 244 participants | Moderate Downgraded: risk of bias |
Time to achieve 12‐month remission (seizure‐free period) Subgroup: generalised onset seizures (tonic‐clonic only) Range of Sodium valproate vs phenytoin monotherapy | HR 0.96 [0.71, 1.29] | 4 studies · 270 participants | Moderate Downgraded: risk of bias |
Comparison
Population: Adults and children with newly‐onset partial or generalised tonic‐clonic seizures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Time to withdrawal of allocated treatment (retention time) ‐ stratified by epilepsy type Range of | HR 1.09 [0.76, 1.55] | 5 studies · 528 participants | Moderate Downgraded: risk of bias |
Time to withdrawal of allocated treatment (retention time) ‐ stratified by epilepsy type: generalised onset seizures (tonic‐clonic only) Range of | HR 0.98 [0.59, 1.64] | 5 studies · 341 participants | Moderate Downgraded: risk of bias |
Time to withdrawal of allocated treatment (retention time) ‐ stratified by epilepsy type: partial onset seizures Range of | HR 1.2 [0.74, 1.95] | 4 studies · 187 participants | Moderate Downgraded: risk of bias |
Time to achieve 12‐month remission (seizure‐free period) ‐ stratified by epilepsy type Range of | HR 0.98 [0.78, 1.23] | 4 studies · 514 participants | Moderate Downgraded: risk of bias |
Time to achieve 12‐month remission (seizure‐free period) ‐ stratified by epilepsy type: generalised onset seizures (tonic‐clonic only) Range of | HR 1.04 [0.77, 1.4] | 4 studies · 270 participants | Low Downgraded: risk of bias, indirectness |
Time to achieve 12‐month remission (seizure‐free period) ‐ stratified by epilepsy type: partial onset seizures Range of | HR 0.9 [0.63, 1.29] | 4 studies · 244 participants | Moderate Downgraded: risk of bias |
Time to achieve 6‐month remission (seizure‐free period) ‐ stratified by epilepsy type Range of | HR 0.95 [0.78, 1.15] | 5 studies · 639 participants | Moderate Downgraded: risk of bias |
Time to achieve 6‐month remission (seizure‐free period) ‐ stratified by epilepsy type: generalised onset seizures (tonic‐clonic only) Range of | HR 0.92 [0.72, 1.18] | 5 studies · 395 participants | Low Downgraded: risk of bias, indirectness |
Time to achieve 6‐month remission (seizure‐free period) ‐ stratified by epilepsy type: partial onset seizures Range of | HR 0.99 [0.73, 1.35] | 4 studies · 244 participants | Moderate Downgraded: risk of bias |
Time to first seizure (post‐randomisation) ‐ stratified by epilepsy type Range of | HR 0.93 [0.75, 1.14] | 5 studies · 639 participants | Low Downgraded: risk of bias, indirectness |
Time to first seizure (post‐randomisation) ‐ stratified by epilepsy type: generalised onset seizures (tonic‐clonic only) Range of | HR 1.03 [0.77, 1.39] | 5 studies · 395 participants | Very low Downgraded: risk of bias, indirectness |
Time to first seizure (post‐randomisation) ‐ stratified by epilepsy type: partial onset seizures Range of | HR 0.83 [0.62, 1.11] | 4 studies · 244 participants | Low Downgraded: risk of bias, indirectness |
Comparison
Population: adults and children with newly‐onset partial or generalised tonic‐clonic seizures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Time to withdrawal of allocated treatment ‐ stratified by epilepsy type Range of | HR 1.09 [0.76, 1.55] | 5 studies · 528 participants | Moderate Downgraded: risk of bias, indirectness |
Time to withdrawal of allocated treatment ‐ stratified by epilepsy type ‐ Generalised onset seizures (tonic‐clonic only) Range of | HR 0.98 [0.59, 1.64] | 5 studies · 341 participants | Moderate Downgraded: risk of bias, indirectness |
Time to withdrawal of allocated treatment ‐ stratified by epilepsy type ‐ Partial onset seizures Range of | HR 1.2 [0.74, 1.95] | 4 studies · 187 participants | Moderate Downgraded: risk of bias, indirectness |
Time to 12‐month remission ‐ stratified by epilepsy type Range of | HR 0.98 [0.78, 1.23] | 4 studies · 514 participants | Moderate Downgraded: risk of bias, indirectness |
Time to 12‐month remission ‐ stratified by epilepsy type ‐ Generalized onset seizures (tonic‐clonic only) Range of | HR 1.04 [0.77, 1.4] | 4 studies · 270 participants | Low Downgraded: risk of bias, indirectness |
Time to 12‐month remission ‐ stratified by epilepsy type ‐ Partial onset seizures Range of | HR 0.9 [0.63, 1.29] | 4 studies · 244 participants | Moderate Downgraded: risk of bias, indirectness |
Time to 6‐month remission ‐ stratified by epilepsy type Range of | HR 0.95 [0.78, 1.15] | 5 studies · 639 participants | Moderate Downgraded: risk of bias, indirectness |
Time to 6‐month remission ‐ stratified by epilepsy type ‐ Generalised onset seizures (tonic‐clonic only) Range of | HR 0.92 [0.72, 1.18] | 5 studies · 395 participants | Low Downgraded: risk of bias, indirectness |
Time to 6‐month remission ‐ stratified by epilepsy type ‐ Partial onset seizures Range of | HR 0.99 [0.73, 1.35] | 4 studies · 244 participants | Moderate Downgraded: risk of bias, indirectness |
Time to first seizure ‐ stratified by epilepsy type Range of | HR 0.93 [0.75, 1.14] | 5 studies · 639 participants | Low Downgraded: risk of bias, indirectness |
Time to first seizure ‐ stratified by epilepsy type ‐ Generalised onset seizures (tonic‐clonic only) Range of | HR 1.03 [0.77, 1.39] | 5 studies · 395 participants | Very low Downgraded: risk of bias, indirectness |
Time to first seizure ‐ stratified by epilepsy type ‐ Partial onset seizures Range of | HR 0.83 [0.62, 1.11] | 4 studies · 244 participants | Low Downgraded: risk of bias, indirectness |