Comparison of Oxcarbazepine and Carbamazepine in the treatment of Trigeminal Neuralgia: a systematic review and meta-analysis

Oxcarbazepine (OXC) has demonstrated comparable efficacy to Carbamazepine (CBZ) in the treatment of Trigeminal neuralgia (TN), with the added benefit of fewer adverse events (AEs). Whether it can be used as a substitute for carbamazepine is yet to be verified. To address this, we conducted a comprehensive meta-analysis, exploring efficacy and adverse events in detail. We searched PubMed, Embase, Cochrane Library, and Google Scholar for studies comparing CBZ to OXC in patients with TN. The main outcomes were efficacy, AEs, frequency of neurological AEs, skin reactions, and alterations in laboratory parameters. Statistical analysis was performed using Review Manager 5.4.1. And the risk of bias was assessed using RoB-2 and ROBINS-I. We included 838 patients from three observational studies and two randomized clinical trials (RCTs). CBZ was used to treat TN in 445 (53.1%) patients. The CBZ group when compared with the OXC group had no significant difference in efficacy (OR:0.58; 95% Cl:0.14-2.40; p=0.45). Both groups had significant differences noted in AEs, with higher frequency observed in the CBZ group (OR:2.30; 95% Cl:1.49-3.54; p=0.0002). Similarly, there was a significant difference in neurological AEs (OR:2.76; 95% Cl:1.53-4.87; p=0.0007). OXC and CBZ demonstrated similar efficacy in treating trigeminal neuralgia. However, the consideration of adverse events may favor clinical decision-making to OXC due to its superiority. Nonetheless, more randomized controlled trials (RCTs) are necessary to confirm this conclusion in the future