左乙拉西坦与奥卡西平治疗儿童癫痫的疗效和安全性：一项系统评价和荟萃分析
Efficacy and safety of levetiracetam vs. oxcarbazepine in the treatment of children with epilepsy: a systematic review and meta-analysis.
作者信息
Liu Yuanyuan, Wang Yanxu, Li Xingzhou, Wu Xiaomin
机构信息
School of Public Health, Jiamusi University, Jiamusi, China.
Department of Food Hygiene Monitoring, Jiamusi City Center for Disease Control and Prevention, Jiamusi, China.
出版信息
Front Pediatr. 2024 Apr 22;12:1336744. doi: 10.3389/fped.2024.1336744. eCollection 2024.
BACKGROUND
Levetiracetam (LEV) and oxcarbazepine (OXC) are new antiseizure medications (ASMs). In recent years, OXC monotherapy is widely used in children with epilepsy; however, no consensus exists on applying LEV monotherapy among children with epilepsy.
OBJECTIVE
The present work focused on comparing the efficacy and safety of LEV and OXC monotherapy in treating children with epilepsy.
METHODS
We conducted a comprehensive search across multiple databases including PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang Database, VIP, and China Biology Medicine disc, covering studies from inception to August 26, 2023. We included randomized controlled trials (RCTs) and cohort studies evaluating the efficacy and safety of LEV and OXC monotherapy for treating epilepsy in children. We utilized Cochrane Risk of Bias Tool in RevMan 5.3 software for assessing included RCTs quality. In addition, included cohort studies quality was determined using Newcastle-Ottawa Scale (NOS). A random-effects model was utilized to summarize the results.
RESULTS
This meta-analysis included altogether 14 studies, including 893 children with epilepsy. LEV and OXC monotherapy was not statistical different among children with epilepsy in seizure-free rate (relative risk [RR] = 1.010, 95% confidence interval [CI] [0.822, 1.242], > 0.05) and seizure frequency decrease of ≥50% compared with baseline [RR = 0.938, 95% CI (0.676, 1.301), > 0.05]. Differences in total adverse reaction rate [RR = 1.113, 95% CI (0.710, 1.744), > 0.05] and failure rate because of serious adverse reaction [RR = 1.001, 95% CI (0.349, 2.871), > 0.05] were not statistical different between LEV and OXC treatments among children with epilepsy. However, the effects of OXC monotherapy on thyroid among children with epilepsy was statistically correlated than that of LEV (thyroid stimulating hormone: standardized mean difference [SMD] = -0.144, 95% CI [-0.613, 0.325], > 0.05; free thyroxine: SMD = 1.663, 95% CI [0.179, 3.147], < 0.05).
CONCLUSION
The efficacy of LEV and OXC monotherapy in treating children with epilepsy is similar. However, OXC having a more significant effect on the thyroid than that of LEV. Therefore, LEV may be safer for children with epilepsy who are predisposed to thyroid disease than OXC.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/, PROSPERO (CRD42024514016).
背景
左乙拉西坦（LEV）和奥卡西平（OXC）是新型抗癫痫药物（ASMs）。近年来，奥卡西平单药治疗在癫痫患儿中广泛应用；然而，对于癫痫患儿应用左乙拉西坦单药治疗尚无共识。
目的
本研究旨在比较左乙拉西坦和奥卡西平单药治疗癫痫患儿的疗效和安全性。
方法
我们对多个数据库进行了全面检索，包括PubMed、Cochrane图书馆、Embase、科学网、中国知网、万方数据库、维普和中国生物医学光盘，涵盖从创刊到2023年8月26日的研究。我们纳入了评估左乙拉西坦和奥卡西平单药治疗儿童癫痫疗效和安全性的随机对照试验（RCTs）和队列研究。我们使用RevMan 5.3软件中的Cochrane偏倚风险工具评估纳入的RCTs质量。此外，使用纽卡斯尔-渥太华量表（NOS）确定纳入的队列研究质量。采用随机效应模型汇总结果。
结果
本荟萃分析共纳入14项研究，包括893例癫痫患儿。左乙拉西坦和奥卡西平单药治疗在癫痫患儿的无发作率（相对危险度[RR]=1.010，95%置信区间[CI][0.822,1.242]，>0.05）和与基线相比发作频率降低≥50%方面无统计学差异[RR=0.938，95%CI（0.676,1.301），>0.05]。左乙拉西坦和奥卡西平治疗癫痫患儿的总不良反应率[RR=1.113，95%CI（0.710,1.744），>0.05]和因严重不良反应导致的失败率[RR=1.001，95%CI（0.349,2.871），>0.05]差异无统计学意义。然而，奥卡西平单药治疗对癫痫患儿甲状腺的影响与左乙拉西坦相比具有统计学相关性（促甲状腺激素：标准化均数差[SMD]=-0.144，95%CI[-0.613,0.325]，>0.05；游离甲状腺素：SMD=1.663，95%CI[0.179,3.147]，<0.05）。
结论
左乙拉西坦和奥卡西平单药治疗癫痫患儿的疗效相似。然而，奥卡西平对甲状腺的影响比左乙拉西坦更显著。因此，对于易患甲状腺疾病的癫痫患儿，左乙拉西坦可能比奥卡西平更安全。
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