Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China.
Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China.
CNS Drugs. 2020 Dec;34(12):1205-1215. doi: 10.1007/s40263-020-00770-0. Epub 2020 Oct 27.
Recent studies have shown conflicting results regarding the effectiveness of levetiracetam for treating benzodiazepine-refractory status epilepticus (SE) compared with phenytoin. Therefore, a meta-analysis was carried out to assess the value of levetiracetam versus phenytoin in the pharmacotherapy of benzodiazepine-refractory SE.
The aim of this systematic review and meta-analysis was to compare the efficacy and safety of levetiracetam and phenytoin in the treatment of benzodiazepine-refractory SE.
The MEDLINE, EMBASE, CENTRAL and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs) that had been conducted to evaluate levetiracetam versus phenytoin for benzodiazepine-refractory SE, to April 2020. The data were assessed using Review Manager 5.3 software. The risk ratio (RR) was analyzed using dichotomous outcomes, and calculated using a random-effect model.
We pooled 1850 patients from 12 RCTs. Patients in the levetiracetam group had a significantly higher rate of clinical seizure cessation than in the phenytoin group (75.2% vs. 67.8%; RR 1.14, 95% confidence interval [CI] 1.05-1.25, p = 0.003). Moreover, less adverse events were observed in the levetiracetam group than in the phenytoin group (17.8% vs. 21.4%; RR 0.82, 95% CI 0.70-0.97, p = 0.02). In subgroup analysis, clinical seizure cessation was achieved more frequently with a higher dose of levetiracetam (> 30 mg/kg) [RR 1.15, 95% CI 1.00-1.32, p = 0.05]. Furthermore, in the subgroup of children, levetiracetam showed a higher rate of clinical seizure cessation than phenytoin (RR 1.13, 95% CI 1.02-1.25, p = 0.02).
Pharmacotherapy for BZD-refractory SE by LEV is superior to PHT in efficacy and safety outcomes.
最近的研究表明，左乙拉西坦在治疗苯二氮䓬类药物难治性癫痫持续状态（SE）方面的疗效与苯妥英钠相比存在相互矛盾的结果。因此，进行了一项荟萃分析，以评估左乙拉西坦与苯妥英钠在苯二氮䓬类药物难治性 SE 药物治疗中的价值。
本系统评价和荟萃分析的目的是比较左乙拉西坦和苯妥英钠在治疗苯二氮䓬类药物难治性 SE 中的疗效和安全性。
检索 MEDLINE、EMBASE、CENTRAL 和 ClinicalTrials.gov 数据库，以评估左乙拉西坦与苯妥英钠治疗苯二氮䓬类药物难治性 SE 的随机对照试验（RCT），检索时间截至 2020 年 4 月。使用 Review Manager 5.3 软件评估数据。采用二项结局分析风险比（RR），并采用随机效应模型进行计算。
我们从 12 项 RCT 中纳入了 1850 名患者。左乙拉西坦组的临床癫痫发作停止率明显高于苯妥英钠组（75.2%比 67.8%；RR 1.14，95%置信区间 [CI] 1.05-1.25，p=0.003）。此外，左乙拉西坦组的不良事件发生率低于苯妥英钠组（17.8%比 21.4%；RR 0.82，95% CI 0.70-0.97，p=0.02）。亚组分析显示，较高剂量的左乙拉西坦（>30mg/kg）更能频繁地达到临床癫痫发作停止[RR 1.15，95% CI 1.00-1.32，p=0.05]。此外，在儿童亚组中，左乙拉西坦的临床癫痫发作停止率高于苯妥英钠（RR 1.13，95% CI 1.02-1.25，p=0.02）。
左乙拉西坦治疗苯二氮䓬类药物难治性 SE 的疗效和安全性优于苯妥英钠。
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