Klein P, Devinsky O, French J, et al. - In this meta-analysis of phase 2 and 3 randomized placebo-controlled epilepsy trials of antiseizure medications approved since 2008, there is currently no evidence that the five antiseizure medications (ASMs) ie, eslicarbazepine, perampanel, brivaracetam, cannabidiol, and cenobamate, studied in this research increase suicidality in epilepsy patients and should be labelled with a suicidality class warning.

• Excluding studies that did not assess suicidality (everolimus and fenfluramine) or did not assess it prospectively (lacosamide, ezogabine, and clobazam), 5 drugs were studied: eslicarbazepine, perampanel, brivaracetam, cannabidiol, and cenobamate.

• Suicidality was assessed in 17 randomized clinical trials involving 5,996 patients, 4,000 of whom were treated with ASMs and 1,996 with placebo.

• Overall, or for any individual drug, there was no evidence of an elevated risk of suicide ideation or attempt.

• Suicidal ideation occurred in 12 of 4,000 ASM-treated patients (0.30%), compared with 7 of 1,996 placebo-treated individuals (0.35%).

• Three ASM-treated individuals attempted suicide, while none of the placebo-treated patients did.

• There were no suicides that were completed.