Li Yulong, Su Shen, Zhang Mengwen, Yu Limin, Miao Xinyuan, Li Hongjun, Sun Yanping
Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.
Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China.
Front Neurol. 2024 Feb 14;15:1295368. doi: 10.3389/fneur.2024.1295368. eCollection 2024.
Antiseizure medications (ASMs) are first line therapy for seizure disorders. Their effects on arrhythmias, especially the risk of arrhythmias associated with lacosamide (LCM), levetiracetam (LEV), and perampanel (PER), have been intensely investigated.
We searched four databases (PubMed, EMBASE, Cochrane Library, and Web of Science) until August 6, 2023. We used a common effects model and reported data as pooled incidence with 95% CIs. Meta-analyses were conducted to elucidate the risk of arrhythmias with different drugs, and Egger's regression was performed to detect publication bias analysis.
We included 11 clinical trials with 1,031 participants. The pooled incidence of arrhythmias in the LEV group was 0.005 (95% CI: 0.001-0.013), while it was 0.014 in the LCM group (95% CI: 0.003-0.030). Publication bias analyses indicated no significant bias in the LEV group ( = 0.02, df = 4, -value = 0.9852) but a significant bias in the LCM group ( = 5.94, df = 3, -value = 0.0095). We corrected for this bias in the LCM group using the trim-and-fill method, which yielded a similar pooled incidence of 0.0137 (95% CI: 0.0036-0.0280), indicating good reliability. Due to insufficient studies, we could not conduct a meta-analysis for PER, and we analyzed them in our systematic review.
The use of LCM significantly elevated the risk of arrhythmias, while LEV had non-significant arrhythmogenic effects. As for the arrhythmogenic effects of PER, more clinical trials are needed in the future.
抗癫痫药物（ASMs）是癫痫疾病的一线治疗药物。它们对心律失常的影响，尤其是与拉科酰胺（LCM）、左乙拉西坦（LEV）和吡仑帕奈（PER）相关的心律失常风险，已得到深入研究。
我们检索了四个数据库（PubMed、EMBASE、Cochrane图书馆和Web of Science），检索截止至2023年8月6日。我们使用固定效应模型，并将数据报告为合并发病率及95%置信区间。进行荟萃分析以阐明不同药物导致心律失常的风险，并进行Egger回归以检测发表偏倚分析。
我们纳入了11项临床试验，共1031名参与者。LEV组心律失常的合并发病率为0.005（95%置信区间：0.001 - 0.013），而LCM组为0.014（95%置信区间：0.003 - 0.030）。发表偏倚分析表明，LEV组无显著偏倚（Q = 0.02，自由度 = 4，P值 = 0.9852），但LCM组存在显著偏倚（Q = 5.94，自由度 = 3，P值 = 0.0095）。我们使用修剪填充法对LCM组的这种偏倚进行了校正，校正后合并发病率相似，为0.0137（95%置信区间：0.0036 - 0.0280），表明可靠性良好。由于研究不足，我们无法对PER进行荟萃分析，因此在系统评价中对其进行了分析。
使用LCM显著增加了心律失常的风险，而LEV的致心律失常作用不显著。至于PER的致心律失常作用，未来需要更多的临床试验。
