Valproic acid vs lamotrigine: which is better for managing generalised epilepsy- a meta -analysis of comparative studies

Monotherapy is the primary treatment for epilepsy because of its efficacy and safety profile The first-line monotherapy treatment for patients with generalised epilepsies is Valproic acid and lamotrigine (LTG) has been proposed as an alternative to VPA. Tang L et al conducted present study to evaluate the safety and efficacy of lamotrigine on generalised epilepsy seizure in comparison with Valproic acid .

A search was conducted based on the databases from Pubmed, Embase and the Cochran database up to February 2017. The relative risk odds ratios (ORs) and the relevant 95% confidence intervals (CI) were determined.

A meta-analysis of comparative studies (randomised controlled trial [RCT], cohort, case-control, and observational studies) was conducted to compare the effects of Valproic acid and lamotrigine for the treatment of GE.

In the study five randomized controlled trials and four observational cohort studies involving 1732 cases were included. The results indicated that VPA was significantly superior to LTG for the outcome rate to treatment withdrawal for any reason and seizure freedom. The ORs and 95% CI of VPA versus LTG for withdrawal after 12- and 24-month treatment were 0.39(0.27, 0.56) and 0.50(0.14, 1.75), respectively, and were 3.51(2.68, 4.59) and 8.58(5.40, 13.63)for 12- and 24- month seizure free intervals, respectively. Moreover, the risk of adverse effects (OR (95%CI); 1.11(0.61–2.01)) was not significantly different between the two groups. However, the treatment withdrawal due to lack of seizure control were in the LTG group (OR (95%CI); 0.15(0.10–0.23)), while the treatment withdrawal due to intolerable side effects were in the VPA group (OR (95%CI); (1.75(1.10–2.80)). There were no significant differences in terms of adverse reactions between groups.

It was concluded in the meta-analysis that Valproic acid was a better choice and was more effective than lamotrigine in controlling seizures after GE. Alternative monotherapy should be considered if Valproic acid monotherapy is not effective or intolerableespecially in young woman.