Switching from oxcarbazepine to eslicarbazepine in patients with focal epilepsy: A systematic review and single-arm meta-analysis.

BACKGROUND

Oxcarbazepine (OXC) is widely used in focal epilepsy but is frequently limited by tolerability issues, particularly neurovestibular and sedative adverse events. Switching to eslicarbazepine acetate (ESL) has emerged in clinical practice as a pragmatic strategy to improve tolerability, although the available evidence remains fragmented and predominantly observational.

MATERIAL AND

METHODS

We conducted a systematic review and single-arm meta-analysis of studies reporting outcomes after switching from OXC to ESL in patients with focal epilepsy. PubMed, Embase, Scopus, Cochrane Library, and Web of Science were searched from inception to December 2025. Random-effects models were used to estimate pooled proportions for effectiveness and tolerability outcomes. Heterogeneity was assessed using the I² statistic.

RESULTS

Seven studies comprising 312 patients were included. Pooled treatment retention was 74.0% (95% CI: 45.9-90.5; I²=79.2%). Resolution of OXC-related adverse events was observed in 53.1% of patients (95% CI: 12.3-90.1; I²=87.3%), although estimates showed substantial variability across studies. Somnolence improvement was reported in 28.2% (95% CI: 4.3-77.4%). The pooled response rate (≥50% seizure reduction) was 22.1% (95% CI: 6.4-53.9), while seizure freedom was achieved in 14.2% (95% CI: 4.5-37.2). Treatment discontinuation occurred in 15.0% of patients (95% CI: 7.2-28.6).

CONCLUSION

Switching from OXC to ESL may represent a pragmatic strategy for patients with OXC-related intolerance, particularly when treatment retention and tolerability are prioritized. However, the observational nature of the available evidence, together with substantial heterogeneity and wide confidence intervals, limits the precision and generalizability of pooled estimates.