Impact of levetiracetam use in glioblastoma: an individual patient-level meta-analysis assessing overall survival.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.