evidencegaps
Cochrane · systematic review · CD001904

Carbamazepine versus phenobarbitone monotherapy for epilepsy: an individual participant data review

Nevitt, SJ, Marson, AG, Tudur Smith, C · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library

Epilepsy3 versionsAMSTAR 2: not assessed
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 6 · 66.7%Moderate 3 · 33.3%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 only

Carbamazepine compared with phenobarbitone for epilepsy (time to treatment failure)

Population: adults and children with newly onset focal or generalised epilepsy
CD001904.PUB4 (current) · 3 questions
OutcomeEffectEvidenceStatus / GRADE
Time to treatment failure (any reason related to treatment) All participants Range of
Carbamazepine vs phenobarbitone
HR 0.66 [0.5, 0.86]4 studies · 676 participantsModerate
Downgraded: risk of bias, inconsistency
Time to treatment failure (any reason related to treatment) Subgroup: focal onset seizures Range of
Carbamazepine vs phenobarbitone
HR 0.66 [0.49, 0.88]4 studies · 520 participantsLow
Downgraded: risk of bias, inconsistency
Time to treatment failure (any reason related to treatment) Subgroup: generalised onset tonic‐clonic seizures Range of
Carbamazepine vs phenobarbitone
HR 0.65 [0.35, 1.23]3 studies · 156 participantsLow
Downgraded: risk of bias, imprecision, inconsistency, indirectness

Carbamazepine compared with phenobarbitone for epilepsy (secondary outcomes)

Population: adults and children with newly onset focal or generalised epilepsy
CD001904.PUB4 (current) · 6 questions
OutcomeEffectEvidenceStatus / GRADE
Time to first seizure (post‐randomisation) All participants Range of
Carbamazepine vs phenobarbitone
HR 1.13 [0.93, 1.38]6 studies · 822 participantsModerate
Downgraded: risk of bias, inconsistency
Time to first seizure (post‐randomisation) Subgroup: focal onset seizures Range of
Carbamazepine vs phenobarbitone
HR 1.31 [1.04, 1.66]6 studies · 584 participantsModerate
Downgraded: risk of bias, inconsistency
Time to first seizure (post‐randomisation) Subgroup: generalised onset tonic‐clonic seizures Range of
Carbamazepine vs phenobarbitone
HR 0.8 [0.55, 1.15]5 studies · 238 participantsLow
Downgraded: risk of bias, inconsistency
Time to achieve 12‐month remission (seizure‐free period) All participants Range of
Carbamazepine vs phenobarbitone
HR 1.09 [0.84, 1.4]4 studies · 683 participantsLow
Downgraded: risk of bias, inconsistency
Time to achieve 12‐month remission (seizure‐free period) Subgroup: focal onset seizures Range of
Carbamazepine vs phenobarbitone
HR 0.92 [0.67, 1.25]4 studies · 525 participantsLow
Downgraded: risk of bias, inconsistency
Time to achieve 12‐month remission (seizure‐free period) Subgroup: generalised onset tonic‐clonic seizures Range of
Carbamazepine vs phenobarbitone
HR 1.56 [0.99, 2.44]3 studies · 158 participantsLow
Downgraded: risk of bias, imprecision, inconsistency, indirectness

Summary of findings ‐ Carbamazepine compared with phenobarbitone for epilepsy (primary outcome)

Population: adults and children with newly onset partial or generalised epilepsy
CD001904.PUB3 · 3 questions
OutcomeEffectEvidenceStatus / GRADE
Time to withdrawal of allocated treatment ‐ all participants, stratified by epilepsy type Range of
Summary of findings ‐ Carbamazepine vs phenobarbitone
HR 1.5 [1.15, 1.95]4 studies · 676 participantsLow
Downgraded: risk of bias, inconsistency
Time to withdrawal of allocated treatment Subgroup: generalised onset seizures Range of
Summary of findings ‐ Carbamazepine vs phenobarbitone
HR 1.53 [0.81, 2.88]3 studies · 156 participantsLow
Downgraded: risk of bias, inconsistency
Time to withdrawal of allocated treatment Subgroup: partial onset seizures Range of
Summary of findings ‐ Carbamazepine vs phenobarbitone
HR 1.49 [1.12, 2]4 studies · 520 participantsLow
Downgraded: risk of bias, inconsistency

Summary of findings ‐ Carbamazepine compared with phenobarbitone for epilepsy (secondary outcome)

Population: adults and children with newly onset partial or generalised epilepsy
CD001904.PUB3 · 6 questions
OutcomeEffectEvidenceStatus / GRADE
Time to achieve 12‐month remission ‐ all participants, stratified by epilepsy type Range of
Summary of findings ‐ Carbamazepine vs phenobarbitone
HR 0.93 [0.72, 1.2]4 studies · 683 participantsLow
Downgraded: risk of bias, inconsistency
Time to achieve 12‐month remission Subgroup: generalised onset seizures Range of
Summary of findings ‐ Carbamazepine vs phenobarbitone
HR 0.64 [0.41, 1.01]3 studies · 158 participantsLow
Downgraded: risk of bias, inconsistency
Time to achieve 12‐month remission Subgroup: partial onset seizures Range of
Summary of findings ‐ Carbamazepine vs phenobarbitone
HR 1.11 [0.81, 1.51]4 studies · 525 participantsLow
Downgraded: risk of bias, inconsistency
Time to first seizure ‐ all participants, stratified by epilepsy type Range of
Summary of findings ‐ Carbamazepine vs phenobarbitone
HR 0.87 [0.72, 1.06]6 studies · 822 participantsLow
Downgraded: risk of bias, inconsistency
Time to first seizure ‐ Subgroup: generalised onset seizures Range of
Summary of findings ‐ Carbamazepine vs phenobarbitone
HR 1.23 [0.86, 1.77]5 studies · 238 participantsLow
Downgraded: risk of bias, inconsistency
Time to first seizure ‐ Subgroup: partial onset seizures Range of
Summary of findings ‐ Carbamazepine vs phenobarbitone
HR 0.76 [0.6, 0.96]6 studies · 584 participantsLow
Downgraded: risk of bias, inconsistency

Comparison

Population: adults and children with newly onset partial or generalised epilepsy
CD001904.PUB2 · 3 questions
OutcomeEffectEvidenceStatus / GRADE
Time to withdrawal of allocated treatment ‐ stratified by epilepsy type Range of
HR 1.5 [1.15, 1.95]4 studies · 676 participantsLow
Downgraded: risk of bias, inconsistency
Time to withdrawal of allocated treatment ‐ stratified by epilepsy type ‐ generalised onset Range of
HR 1.53 [0.81, 2.88]3 studies · 156 participantsLow
Downgraded: risk of bias, inconsistency
Time to withdrawal of allocated treatment ‐ stratified by epilepsy type ‐ partial onset Range of
HR 1.49 [1.12, 2]4 studies · 520 participantsLow
Downgraded: risk of bias, inconsistency

Comparison

Population: adults and children with newly onset partial or generalised epilepsy
CD001904.PUB2 · 6 questions
OutcomeEffectEvidenceStatus / GRADE
Time to 12‐month remission ‐ stratified by epilepsy type Range of
HR 0.93 [0.72, 1.2]4 studies · 683 participantsLow
Downgraded: risk of bias, inconsistency
Time to 12‐month remission ‐ stratified by epilepsy type ‐ generalised onset Range of
HR 0.64 [0.41, 1.01]3 studies · 158 participantsLow
Downgraded: risk of bias, inconsistency
Time to 12‐month remission ‐ stratified by epilepsy type ‐ partial onset Range of
HR 1.11 [0.81, 1.51]4 studies · 525 participantsLow
Downgraded: risk of bias, inconsistency
Time to 6‐month remission ‐ stratified by epilepsy type Range of
HR 0.99 [0.8, 1.23]4 studies · 683 participantsLow
Downgraded: risk of bias, inconsistency
Time to 6‐month remission ‐ stratified by epilepsy type ‐ generalised onset Range of
HR 0.69 [0.47, 1.01]3 studies · 158 participantsLow
Downgraded: risk of bias, inconsistency
Time to 6‐month remission ‐ stratified by epilepsy type ‐ partial onset Range of
HR 1.17 [0.9, 1.5]4 studies · 525 participantsLow
Downgraded: risk of bias, inconsistency

Comparison

Population: adults and children with newly onset partial or generalised epilepsy
CD001904.PUB2 · 4 questions
OutcomeEffectEvidenceStatus / GRADE
Time to first seizure ‐ stratified by epilepsy type Range of
HR 0.87 [0.72, 1.06]6 studies · 822 participantsLow
Downgraded: risk of bias, inconsistency
Time to first seizure ‐ stratified by epilepsy type ‐ generalised onset Range of
HR 1.23 [0.86, 1.77]5 studies · 238 participantsLow
Downgraded: risk of bias, inconsistency
Time to first seizure ‐ stratified by epilepsy type ‐ partial onset Range of
HR 0.76 [0.6, 0.96]6 studies · 584 participantsLow
Downgraded: risk of bias, inconsistency
Time to first seizure ‐ stratified by epilepsy type (sensitivity analysis) Range of
HR 0.89 [0.73, 1.09]6 studies · 822 participantsModerate
Downgraded: risk of bias, inconsistency