Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Horm Metab Res. 2019 Aug;51(8):511-521. doi: 10.1055/a-0963-0054. Epub 2019 Aug 13.
We conducted this meta-analysis to evaluate effects of second-generation anti-epileptic drugs (AEDs; levetiracetam, lamotrigine) compared to first-generation AEDs (valproic acid, carbamazepine) on bone metabolism in epilepsy patients. PubMed, Web of Science, Clinical trials.gov, Wanfang, and China national knowledge infrastructure databases were searched. Ten trials were included. Results showed: (1) The overall SMD for changes of serum calcium, phosphorus, ALP, and PTH levels from baseline of LEV versus first-generation AEDs were 1.00 (95% CI=0.23-1.77, Z=2.56, p=0.01), 0.98 (95% CI=- 0.05 to 2.01, Z=1.86, p=0.06), - 1.17 (95% CI=- 2.08 to - 0.25, Z=2.50, p=0.01), 0.07 (95% CI=- 0.14 to 0.27, Z=0.63, p=0.53), respectively. (2) The overall SMD for changes of serum calcium, phosphorus, ALP, and PTH levels from baseline of LTG versus first-generation AEDs were -0.16 (95% CI=- 0.47 to 0.16, Z=0.99, p=0.32), -0.05 (95% CI=- 0.55 to 0.44, Z=0.22, p=0.83), 0.10 (95% CI=- 0.53 to 0.73, Z=0.31, p=0.75), -0.05 (95% CI=- 0.52 to 0.42, Z=0.22, p=0.83), respectively. Overall, our results indicate that compared to first-generation AEDs, LEV has less adverse effects on blood bone metabolism markers in epilepsy patients, while LTG does not. However, due to small number of included studies, our results warrant additional research.
我们进行了这项荟萃分析，以评估第二代抗癫痫药物（AED；左乙拉西坦、拉莫三嗪）与第一代 AED（丙戊酸、卡马西平）相比对癫痫患者骨代谢的影响。我们检索了 PubMed、Web of Science、Clinical trials.gov、万方和中国国家知识基础设施数据库。纳入了 10 项试验。结果显示：（1）LEV 与第一代 AED 相比，血清钙、磷、碱性磷酸酶和甲状旁腺激素水平从基线变化的总体 SMD 为 1.00（95%CI=0.23-1.77，Z=2.56，p=0.01）、0.98（95%CI=-0.05 至 2.01，Z=1.86，p=0.06）、-1.17（95%CI=-2.08 至-0.25，Z=2.50，p=0.01）、0.07（95%CI=-0.14 至 0.27，Z=0.63，p=0.53）。（2）LTG 与第一代 AED 相比，血清钙、磷、碱性磷酸酶和甲状旁腺激素水平从基线变化的总体 SMD 为-0.16（95%CI=-0.47 至 0.16，Z=0.99，p=0.32）、-0.05（95%CI=-0.55 至 0.44，Z=0.22，p=0.83）、0.10（95%CI=-0.53 至 0.73，Z=0.31，p=0.75）、-0.05（95%CI=-0.52 至 0.42，Z=0.22，p=0.83）。总体而言，我们的结果表明，与第一代 AED 相比，LEV 对癫痫患者的血液骨代谢标志物的不良影响较小，而 LTG 则没有。然而，由于纳入研究数量较少，我们的结果需要进一步研究。
