奥卡西平与卡马西平治疗前庭阵发症疗效及安全性的meta分析

Efficacy and safety of oxcarbazepine and carbamazepine in the treatment of vestibular paroxysmia:a meta‑analysis

目的系统评价和比较奥卡西平与卡马西平治疗前庭阵发症(VP)的有效性和安全性。方法检索国内外相关数据库(截至2023年3月),收集奥卡西平与卡马西平治疗VP的随机对照试验(RCT),结局指标包括有效率、眩晕程度的视觉模拟评分、眩晕发作频率和不良事件/反应发生率。采用Cochrane偏倚风险评估工具对纳入的研究进行质量评价。应用RevMan 5.3软件进行meta分析,计数资料效应量为比值比(OR)及其95%置信区间(CI),计量资料效应量为均数差(MD)及其95%CI。结果共7项RCT纳入分析,包括476例患者,奥卡西平组236例,卡马西平组240例。meta分析结果显示,奥卡西平和卡马西平治疗VP的总有效率[85.7%(168/196)比85.0%(170/200),OR=1.07,95%CI:0.61~1.86]、治疗后眩晕程度视觉模拟分数下降情况(MD=0.40,95%CI:-0.52~1.32)和眩晕发作频率减少次数(MD=1.15,95%CI:-1.78~4.08)均无明显差异(均P>0.05),但奥卡西平组总体不良事件/反应、头晕/共济失调和恶心/呕吐症状的发生率均明显低于卡马西平组患者[13.6%(32/236)比30.8%(74/240),OR=0.34,95%CI:0.22~0.55,P<0.001;2.1%(5/236)比7.9%(19/240),OR=0.32,95%CI:0.13~0.76,P=0.01;2.4%(5/211)比7.1%(15/211),OR=0.38,95%CI:0.15~0.95,P=0.04]。结论奥卡西平与卡马西平治疗VP的效果相似,但奥卡西平的安全性更好,神经系统和消化系统不良反应的发生率更低。

Objective To systematically evaluate and compare the efficacy and safety of oxcarbazepine and carbamazepine in the treatment of vestibular paroxysmia(VP).Methods Randomized controlled trials(RCTs)of oxcarbazepine versus carbamazepine in the treatment of VP,in which the outcome measures included response rate,visual analogue scale for vertigo and the attack frequency,and incidence of adverse events/reactions were collected by searching relevant databases at home and abroad(up to March 2023).The Cochrane Collaboration′s tool for assessing risk of bias was used to evaluate the quality of the included studies.RevMan 5.3-software was used for meta-analysis.The effect sizes of counting data were odds ratio(OR)and its 95%confidence interval(CI),and those of the measurement data were mean difference(MD)and its 95%CI.Results A total of 7 RCTs and 476 patients were entered in the analysis,including 236 in the oxcarbazepine group and 240 in the carbamazepine group.Meta analysis showed that there were no significant differences in the total effective rate of oxcarbazepine and carbamazepine in the treatment of VP[85.7%(168/196)vs.85.0%(170/200),OR=1.07,95%CI:0.61-1.86],the decrease of visual analogue scale for vertigo after treatment(MD=0.40,95%CI:-0.52-1.32)or the reduction of vertigo frequency after treatment(MD=1.15,95%CI:-1.78-4.08).However,compared to the carbamazepine group,the overall incidence of adverse events/reactions,the incidence of dizziness/ataxia,and incidence of nausea/vomiting in oxcarbazepine group was significantly lower[13.6%(32/236)vs.30.8%(74/240),OR=0.34,95%CI:0.22-0.55,P<0.001;2.1%(5/236)vs.7.9%(19/240),OR=0.32,95%CI:0.13-0.76,P=0.01;2.4%(5/211)vs.7.1%(15/211),OR=0.38,95%CI:0.15-0.95,P=0.04].Conclusion Oxcarbazepine and carbamazepine have similar efficacy in the treatment of VP,but oxcarbazepine has better safety with lower incidence of adverse reactions in the nervous system and digestive system.