Vychopen Martin, Güresir Agi, Basaran Alim Emre, Güresir Erdem, Wach Johannes
Department of Neurosurgery, University Hospital Leipzig, Liebigstraße 20, Leipzig, 04103, Germany.
Neurosurg Rev. 2024 Dec 9;47(1):897. doi: 10.1007/s10143-024-03137-x.
Levetiracetam (Lev), an antiepileptic drug (AED), enhances alkylating chemotherapy sensitivity in glioblastoma (GB) by inhibiting MGMT expression. This meta-analysis evaluates Lev's impact on GB treatment by analyzing overall survival of individual patient data (IPD) from published studies.
IPD was reconstructed using the R package IPDfromKM. Pooled IPD Kaplan-Meier charts of survival stratified by Lev therapy were created using the R package Survminer. One- and two-stage meta-analyses of Lev treatment regarding survival was performed.
Three articles covering 825 patients were included out of 3567 screened records. Lev usage prevalence was 0.36. IPD from 590 IDH wild-type glioblastomas, with a median follow-up of 16.1 months, were utilized. Pooled data revealed median survival times of 19.2 months (95%CI: 16.4-22.0) for Lev users versus 16.5 months (95%CI: 15.2-17.8) for partial/no use (p = 0.006). One-stage meta-analysis indicated a significant association between Lev use and survival in IDH wild-type GB (HR: 1.33, 95%CI: 1.08-1.64, p = 0.007). Two-stage meta-analysis confirmed these results.
This meta-analysis highlights that Lev use may prolong survival in IDH wild-type GB patients. Further randomized trials are needed to confirm these findings and identify subgroups benefiting most from Lev treatment.
左乙拉西坦（Lev）是一种抗癫痫药物（AED），通过抑制MGMT表达增强胶质母细胞瘤（GB）对烷化剂化疗的敏感性。本荟萃分析通过分析已发表研究中的个体患者数据（IPD）来评估左乙拉西坦对GB治疗的影响。
使用R包IPDfromKM重建IPD。使用R包Survminer创建按左乙拉西坦治疗分层的生存合并IPD Kaplan-Meier图表。对左乙拉西坦治疗的生存情况进行了一阶段和两阶段的荟萃分析。
在3567条筛选记录中，纳入了3篇涵盖825例患者的文章。左乙拉西坦的使用患病率为0.36。使用了590例IDH野生型胶质母细胞瘤的IPD，中位随访时间为16.1个月。汇总数据显示，使用左乙拉西坦的患者中位生存时间为19.2个月（95%CI：16.4-22.0），部分/未使用者为16.5个月（95%CI：15.2-17.8）（p = 0.006）。一阶段荟萃分析表明，在IDH野生型GB中，使用左乙拉西坦与生存之间存在显著关联（HR：1.33，95%CI：1.08-1.64，p = 0.007）。两阶段荟萃分析证实了这些结果。
本荟萃分析强调，使用左乙拉西坦可能会延长IDH野生型GB患者的生存期。需要进一步的随机试验来证实这些发现，并确定最能从左乙拉西坦治疗中获益的亚组。
