Objective: To systematically evaluate the overall efficacy and safety of sodium valproate (VPA) combined with lamotrigine (LTG) in epilepsy, so as to provide evidence-based reference for the combined medication for the disease.
Methods: We did a literature review of PubMed, Cochrane Library, EMBase, Wanfang Data, VIP, CNKI and CBM to identify studies published as of December 2015, in which randomized controlled trials (RTCs) of evaluating the efficacy and safety of VPA combined with LTG for patients with epilepsy were reported. We extracted the data of the articles′ first author, time of publication, sample size, patients′ age, medication, course of treatment, type of epilepsy, observation indexes and so on. The modified Jadad scale was used to assess the methodological quality of the included articles.
Results: A total of 16 articles were included, including 15 in Chinese and one in English, involving 1 687 patients. The methodological quality of the included articles was unsatisfactory due to unknown risks existing in the allocation concealment, blind method, and selective reporting. Results of meta-analysis showed that the efficacy of VPA combined with LTG was significantly better than that of VPA [OR=5.76, 95%CI (3.78, 8.78), P<0.001] or that of LTG [OR=2.80, 95%CI (1.83, 4.28), P<0.001], while the adverse reactions in nervous system [RD= -0.04, 95%CI (-0.06, -0.02), P=0.002], digestive system [RD=-0.05, 95%CI (-0.08, -0.02)], blood system [RD= -0.03, 95%CI (-0.05, -0.01), P=0.040], and skin attachment system [RD= -0.04, 95%CI (-0.06, -0.01), P=0.008] were less compared with those of VPA or LTG.
Conclusion: The effect of VPA combined with LTG is better than VPA or LTG along in epilepsy, and it has good tolerance. Due to limitations related to methodology of included studies, large-scale and high-quality RCTs are required for further validation of the conclusion.