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A meta-analysis of levetiracetam for randomized placebo-controlled trials in patients with refractory epilepsy.
Neuropsychiatr Dis Treat 2019; 15:905-917ND

Abstract

Objective

The objective of this study was to investigate the efficacy and safety profile of levetiracetam as add-on therapy in patients with refractory epilepsy.

Methods

Web of Science, MEDLINE (Ovid and PubMed), Cochrane Library, EMBASE, and Google Scholar were systematically searched to identify potential eligible randomized controlled trials by two reviewers independently. Pooled estimates of risk ratios (RRs) for 50%, 75%, and 100% reduction from baseline were calculated using the fixed-effect model or random-effect model. Quality of included studies was assessed with the Cochrane Collaboration's Risk of Bias tool. Serious adverse events and withdrawals induced by interventions and the most common side effects were analyzed.

Results

Seventeen trials with a total of 3,205 participants were included in this meta-analysis, including 14 trials for adulthood and three trials for children. Pooled estimates suggested that levetiracetam was an effective anti-epileptic drug at 1,000-3,000 mg/day (RR =2.00 for 1,000 mg/day, RR =2.68 for 2,000 mg/day, RR =2.18 for 3,000 mg/day) for adults and 60 mg/kg/day (RR =2.00) for children compared to placebo in terms of 50% reduction from baseline. Likewise, as for seizure freedom rate, levetiracetam had an advantage over placebo at 1,000-3,000 mg/day (RR =5.84 for 1,000 mg/day, RR =4.55 for 2,000 mg/day, RR =4.57 for 3,000 mg/day, respectively) for adults and 60 mg/kg/day (RR =4.52) for children. Regarding safety profile, patients treated with levetiracetam had significantly higher occurrence than placebo for somnolence, asthenia, dizziness, infection, nasopharyngitis, anxiety, and irritability; however, most studies reported that these adverse events were mild and transient.

Conclusion

Levetiracetam is an effective anti-epileptic drug for both adults and children with generalized or partial-onset refractory seizures at 1,000-3,000 or 60 mg/kg/day, with a favorable adverse event profile.

Authors+Show Affiliations

Department of Pediatrics, Yancheng Maternal and Child Health Hospital, Yancheng, People's Republic of China, contribute_sci@126.com.Department of Pediatrics, Yancheng Maternal and Child Health Hospital, Yancheng, People's Republic of China, contribute_sci@126.com.Department of Pediatrics, Yancheng Maternal and Child Health Hospital, Yancheng, People's Republic of China, contribute_sci@126.com.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31043782

Citation

Chen, Daye, et al. "A Meta-analysis of Levetiracetam for Randomized Placebo-controlled Trials in Patients With Refractory Epilepsy." Neuropsychiatric Disease and Treatment, vol. 15, 2019, pp. 905-917.
Chen D, Bian H, Zhang L. A meta-analysis of levetiracetam for randomized placebo-controlled trials in patients with refractory epilepsy. Neuropsychiatr Dis Treat. 2019;15:905-917.
Chen, D., Bian, H., & Zhang, L. (2019). A meta-analysis of levetiracetam for randomized placebo-controlled trials in patients with refractory epilepsy. Neuropsychiatric Disease and Treatment, 15, pp. 905-917. doi:10.2147/NDT.S188111.
Chen D, Bian H, Zhang L. A Meta-analysis of Levetiracetam for Randomized Placebo-controlled Trials in Patients With Refractory Epilepsy. Neuropsychiatr Dis Treat. 2019;15:905-917. PubMed PMID: 31043782.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A meta-analysis of levetiracetam for randomized placebo-controlled trials in patients with refractory epilepsy. AU - Chen,Daye, AU - Bian,Hongliang, AU - Zhang,Lanlan, Y1 - 2019/04/11/ PY - 2019/5/3/entrez PY - 2019/5/3/pubmed PY - 2019/5/3/medline KW - adjunctive KW - levetiracetam KW - placebo KW - refractory epilepsy SP - 905 EP - 917 JF - Neuropsychiatric disease and treatment JO - Neuropsychiatr Dis Treat VL - 15 N2 - Objective: The objective of this study was to investigate the efficacy and safety profile of levetiracetam as add-on therapy in patients with refractory epilepsy. Methods: Web of Science, MEDLINE (Ovid and PubMed), Cochrane Library, EMBASE, and Google Scholar were systematically searched to identify potential eligible randomized controlled trials by two reviewers independently. Pooled estimates of risk ratios (RRs) for 50%, 75%, and 100% reduction from baseline were calculated using the fixed-effect model or random-effect model. Quality of included studies was assessed with the Cochrane Collaboration's Risk of Bias tool. Serious adverse events and withdrawals induced by interventions and the most common side effects were analyzed. Results: Seventeen trials with a total of 3,205 participants were included in this meta-analysis, including 14 trials for adulthood and three trials for children. Pooled estimates suggested that levetiracetam was an effective anti-epileptic drug at 1,000-3,000 mg/day (RR =2.00 for 1,000 mg/day, RR =2.68 for 2,000 mg/day, RR =2.18 for 3,000 mg/day) for adults and 60 mg/kg/day (RR =2.00) for children compared to placebo in terms of 50% reduction from baseline. Likewise, as for seizure freedom rate, levetiracetam had an advantage over placebo at 1,000-3,000 mg/day (RR =5.84 for 1,000 mg/day, RR =4.55 for 2,000 mg/day, RR =4.57 for 3,000 mg/day, respectively) for adults and 60 mg/kg/day (RR =4.52) for children. Regarding safety profile, patients treated with levetiracetam had significantly higher occurrence than placebo for somnolence, asthenia, dizziness, infection, nasopharyngitis, anxiety, and irritability; however, most studies reported that these adverse events were mild and transient. Conclusion: Levetiracetam is an effective anti-epileptic drug for both adults and children with generalized or partial-onset refractory seizures at 1,000-3,000 or 60 mg/kg/day, with a favorable adverse event profile. SN - 1176-6328 UR - https://www.unboundmedicine.com/medline/citation/31043782/A_meta-analysis_of_levetiracetam_for_randomized_placebo-controlled_trials_in_patients_with_refractory_epilepsy L2 - https://dx.doi.org/10.2147/NDT.S188111 DB - PRIME DP - Unbound Medicine ER -
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