Background

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.

Objective

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.

Methods

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.

Results

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).

Conclusion

Pharmacotherapy for BZD-refractory SE by LEV is superior to PHT in efficacy and safety outcomes.

中文翻译：

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左乙拉西坦与苯妥英用于苯二氮卓类难治性癫痫持续状态的药物治疗：随机对照试验的系统评价和荟萃分析

背景

最近的研究表明，与苯妥英钠相比，左乙拉西坦治疗苯二氮卓类难治性癫痫持续状态 (SE) 的有效性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在苯二氮卓类难治性 SE 药物治疗中的价值。

客观的

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治疗苯二氮卓难治性 SE 的疗效和安全性。

方法

在 MEDLINE、EMBASE、CENTRAL 和 ClinicalTrials.gov 数据库中搜索了截至 2020 年 4 月用于评估左乙拉西坦与苯妥英治疗苯二氮卓难治性 SE 的随机对照试验 (RCT)。使用 Review Manager 5.3 软件评估数据。风险比 (RR) 使用二分类结果进行分析，并使用随机效应模型计算。

结果

我们汇集了来自 12 项 RCT 的 1850 名患者。左乙拉西坦组患者的临床癫痫发作停止率显着高于苯妥英组（75.2% 与 67.8%；RR 1.14，95% 置信区间 [CI] 1.05–1.25，p  = 0.003）。此外，左乙拉西坦组观察到的不良事件少于苯妥英组（17.8% 对 21.4%；RR 0.82，95% CI 0.70–0.97，p  = 0.02）。在亚组分析中，较高剂量的左乙拉西坦 (> 30 mg/kg) 更频繁地实现临床癫痫停止 [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停止率高于苯妥英（RR 1.13，95% CI 1.02–1.25，p  = 0.02）。

结论

LEV 治疗 BZD 难治性 SE 的疗效和安全性结果优于 PHT。