A study protocol for a pragmatic randomised controlled trial comparing the effectiveness and cost effectiveness of levetiracetam and zonisamide versus standard treatments for epilepsy: a comparison of Standard And New Antiepileptic Drugs (SANAD-II)

Balbanova, S. et al. (2020) A study protocol for a pragmatic randomised controlled trial comparing the effectiveness and cost effectiveness of levetiracetam and zonisamide versus standard treatments for epilepsy: a comparison of Standard And New Antiepileptic Drugs (SANAD-II). BMJ Open, 10(8), (doi: 10.1136/bmjopen-2020- 040635) (PMID:32847927) (PMCID:PMC7451282)

Abstract

Introduction: Antiepileptic drugs (AEDs) are the mainstay of epilepsy treatment. Over the past 20 years, a number of new drugs have been approved for National Health Service (NHS) use on the basis of information from short-term trials that demonstrate efficacy. These trials do not provide information about the longer term outcomes, which inform treatment policy. This trial will assess the long-term clinical and cost-effectiveness of the newer treatment levetiracetam and zonisamide. Methods and analysis: This is a phase IV, multicentre, open-label, randomised, controlled clinical trial comparing new and standard treatments for patients with newly diagnosed epilepsy. Arm A of the trial randomised 990 patients with focal epilepsy to standard AED lamotrigine or new AED levetiracetam or zonisamide. Arm B randomised 520 patients with generalised epilepsy to standard AED sodium valproate or new AED levetiracetam. Patients are recruited from UK NHS outpatient epilepsy, general neurology and paediatric clinics. Included patients are aged 5 years or older with two or more spontaneous seizures requiring AED monotherapy, who are not previously treated with AEDs. Patients are followed up for a minimum of 2 years. The primary outcome is time to 12-month remission from seizures. Secondary outcomes include time to treatment failure (including due to inadequate seizure control or unacceptable adverse reactions); time to first seizure; time to 24-month remission; adverse reactions and quality of life. All primary analyses will be on an intention to treat basis. Separate analyses will be undertaken for each arm. Health economic analysis will be conducted from the perspective of the NHS to assess the cost-effectiveness of each AED. Ethics and dissemination: This trial has been approved by the North West-Liverpool East REC (Ref. 12/NW/0361). The trial team will disseminate the results through scientific meetings, peer-reviewed publications and patient and public involvement. Trial registration numbers: EudraCT 2012-001884-64; ISRCTN30294119.

• Item Type: Articles
• Additional Information: Funding: This work is supported by the Health Technology Assessment Programme (HTA) of National Institute for Health Research (NIHR) grant number 09/144/09. The SANADII trial is cosponsored by the University of Liverpool (Sponsor Representative Alex Astor [[e-mail]]) and The Walton Centre (Sponsor Representative Martin Wilby [[e-mail]])
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Leach, Dr John Paul and Sills, Dr Graeme
• Authors: Balbanova, S., Taylor, C., Sills, G., Burnside, G., Plumpton, C., Smith, P., Appleton, R., Leach, J. P., Johnson, M., Baker, G., Pirmohamed, M., Hughes, D., Williamson, P., Tudur-Smith, C., and Marson, A.
• College/School: College of Medical Veterinary and Life Sciences > School of Life Sciences; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: BMJ Open
• Publisher: BMJ Publishing Group
• ISSN: 2044-6055
• ISSN (Online): 2044-6055
• Copyright Holders: Copyright © Author(s) (or their employer(s)) 2020
• First Published: First published in BMJ Open 10(8):e040635
• Publisher Policy: Reproduced under a Creative Commons license