{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T15:35:30Z","timestamp":1793892930457,"version":"4.8.0"},"reference-count":53,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,12,11]],"date-time":"2023-12-11T00:00:00Z","timestamp":1702252800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Antiseizure medications (ASMs) are commonly categorized as enzyme\u2010inducers and non\u2010enzyme\u2010inducers based on their propensity to enhance the metabolism of concomitantly administered drugs. This systematic review and network meta\u2010analysis aimed to rank ASMs as cytochrome P450 3A (CYP3A)\u2010inducers based on a comparative assessment of ASM\u2010induced reduction in the concentrations of sensitive substrate drugs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews; CRD42022335846), and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta\u2010Analysis) standards were followed. We searched MEDLINE, Embase, and Cochrane until March 14, 2023 without an initial date restriction. Data were additionally obtained via the US Food and Drug Administration database. Studies had to be prospective, with ASM monotherapy for \u22655\u2009days. The primary parameter was the magnitude of change in the area under the concentration\u2013time curve of CYP3A substrates following treatment with the ASM. The standardized mean difference (SMD) was used as the point estimate for the indirect comparisons between ASMs using the pairwise method. Bias risk was assessed using the PKclin tool.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 14 open\u2010label, fixed\u2010sequence studies with 370 participants. The effect size of 600\u2009mg\/day carbamazepine did not differ from those of 300\u2009mg\/day phenytoin (SMD = \u2212.06, 95% confidence interval [CI] = \u2212.18 to .07) and 200\u2009mg\/day cenobamate (SMD = \u2212.11, 95% CI = \u2212.26 to .04). Carbamazepine at 600\u2009mg\/day was the strongest CYP3A\u2010inducer (<jats:italic>P<\/jats:italic>\u2010score = .88), followed by carbamazepine 400\u2009mg\/day (.83), phenytoin 300\u2009mg\/day (.79), and cenobamate 200\u2009mg\/day (.73). Eslicarbazepine (800\u2009mg\/day) ranked higher than cenobamate 100\u2009mg\/day and oxcarbazepine 900\u2009mg\/day (.60, .39, and .37, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>Despite the limited number of studies, our network meta\u2010analysis emphasizes that the magnitude of ASM effects on CYP3A substrate metabolism is a dose\u2010dependent continuum. When possible, ASM classification as inducers should apply cutoff values tailored to the outcome. Prescribers should monitor plasma concentrations or clinical effects of CYP3A substrates and consider selecting concomitant medications accordingly.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.17822","type":"journal-article","created":{"date-parts":[[2023,11,28]],"date-time":"2023-11-28T00:44:02Z","timestamp":1701132242000},"page":"445-455","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["The extent of cytochrome P450 3A induction by antiseizure medications: A systematic review and network meta\u2010analysis"],"prefix":"10.1111","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-0461-4272","authenticated-orcid":false,"given":"Hagar","family":"Cohen","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy, Faculty of Medicine, School of Pharmacy Hebrew University of Jerusalem  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5895-0680","authenticated-orcid":false,"given":"Ghadeer","family":"Mahajna","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, Faculty of Medicine, School of Pharmacy Hebrew University of Jerusalem  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0415-566X","authenticated-orcid":false,"given":"Tomer","family":"Ben\u2010Shushan","sequence":"additional","affiliation":[{"name":"Medical Library Authority Hebrew University of Jerusalem  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1559-9258","authenticated-orcid":false,"given":"Ilan","family":"Matok","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, Faculty of Medicine, School of Pharmacy Hebrew University of Jerusalem  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1275-6094","authenticated-orcid":false,"given":"Sara","family":"Eyal","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, Faculty of Medicine, School of Pharmacy Hebrew University of Jerusalem  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,12,11]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2018.24"},{"issue":"2","key":"e_1_2_10_3_1","first-page":"428","article-title":"Seizures and epilepsy in childhood","volume":"28","author":"Gogou M","year":"2022","journal-title":"Continuum"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1586\/ern.09.136"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.3880"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2021.108031"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.2165\/00023210-200822010-00003"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.2005.02529.x"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000341789.77291.8d"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2023.1580"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2021.3424"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2021.4584"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-021-00795-z"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-019-00677-5"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.17464"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31823efcf8"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/15357597221088415"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.17212"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40262-022-01152-z"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.12452"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pharmthera.2012.12.007"},{"key":"e_1_2_10_22_1","volume-title":"Antiepileptic drug interactions","author":"Patsalos P","year":"2023"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2012.03671.x"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14-2385"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n160"},{"key":"e_1_2_10_26_1","unstructured":"FDA.Drug development and drug interactions|table of substrates inhibitors and inducers.2022[cited 2023 Mar 20]. 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