Comparative efficacy and safety of second-line medications for status epilepticus: A network meta-analysis.

IF 1.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL Medicine Pub Date : 2024-11-15 DOI:10.1097/MD.0000000000040333

Qishun Zhang, Shaokang Peng, Ziyi Wei, Xiangshu Cheng

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Abstract

Background: To systematically review the efficacy and safety of second-line medications for status epilepticus (SE).

Methods: Electronic searches were conducted in PubMed, Embase, and The Cochrane Library for randomized controlled trials of second-line medications for SE from inception to January 2024. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Network meta-analysis was performed using R 4.2.2 software.

Results: A total of 23 randomized controlled trials were analyzed, examining the efficacy of 5 different treatment regimens: levetiracetam (LEV), phenytoin (PHT), fosphenytoin (FPHT), valproate (VPA), and phenobarbital (PHB). The results of the network meta-analysis indicated that the seizure control rate ranking was as follows: PHB (98.1%) > LEV (60.7%) > FPHT (40.3%) > PHT (33.0%) > VPA (17.8%). The surface under the cumulative ranking (SUCRA) values revealed that PHB had the highest ranking (SUCRA, 91.8%), followed by VPA (SUCRA, 69.3%), PHT (SUCRA, 56.1%), and FPHT (SUCRA, 5.9%) for the recurrence of seizures within 24 hours. Subgroup analysis revealed that PHB was most effective for seizure control in both pediatric and adult populations, VPA demonstrated superior efficacy in children across various indicators, LEV was deemed the safest option for children and elderly individuals, and VPA was identified as the safest choice for adult patients.

Conclusions: PHB continues to be a prominent option for managing SE, although its safety profile warrants careful consideration. Meanwhile, both VPA and LEV offer distinctive advantages in the treatment of SE, with each demonstrating commendable safety profiles.

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癫痫状态二线药物的疗效和安全性比较：网络荟萃分析

背景：系统回顾治疗癫痫状态（SE）的二线药物的疗效和安全性：系统回顾治疗癫痫状态（SE）的二线药物的有效性和安全性：在 PubMed、Embase 和 Cochrane 图书馆中对从开始到 2024 年 1 月的癫痫状态二线药物随机对照试验进行了电子检索。两名审稿人独立筛选文献、提取数据并评估纳入研究的偏倚风险。使用 R 4.2.2 软件进行网络荟萃分析：共分析了23项随机对照试验，考察了5种不同治疗方案的疗效：左乙拉西坦（LEV）、苯妥英（PHT）、磷苯妥英（FPHT）、丙戊酸钠（VPA）和苯巴比妥（PHB）。网络荟萃分析的结果表明，癫痫发作控制率的排序如下：PHB（98.1%）>LEV（60.7%）>FPT（40.3%）>PHT（33.0%）>VPA（17.8%）。累积排名表面值（SUCRA）显示，在 24 小时内癫痫复发方面，PHB 的排名最高（SUCRA，91.8%），其次是 VPA（SUCRA，69.3%）、PHT（SUCRA，56.1%）和 FPHT（SUCRA，5.9%）。亚组分析显示，PHB 对儿童和成人癫痫发作控制最有效，VPA 在儿童中的各项指标均显示出更优越的疗效，LEV 被认为是儿童和老年人最安全的选择，VPA 被认为是成人患者最安全的选择：结论：PHB 仍是治疗 SE 的一个重要选择，但其安全性值得慎重考虑。同时，VPA和LEV在治疗SE方面都具有独特的优势，并且都表现出了值得称道的安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Medicine 医学-医学：内科

CiteScore

2.80

自引率

0.00%

发文量

4342

审稿时长

>12 weeks

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