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

IF 2.5 3区医学 Q2 CLINICAL NEUROLOGY Neurosurgical Review Pub Date : 2024-12-09 DOI:10.1007/s10143-024-03137-x

Martin Vychopen, Agi Güresir, Alim Emre Basaran, Erdem Güresir, Johannes Wach

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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.

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左乙拉西坦对胶质母细胞瘤的影响：一项评估总生存率的个体患者水平荟萃分析。

背景：左乙莱西坦（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）的烷基化化疗敏感性。本荟萃分析通过分析已发表研究的个体患者总生存率（IPD）来评估Lev对GB治疗的影响。方法：利用km的R包ipd重建IPD。使用R包Survminer创建Lev治疗分层的IPD Kaplan-Meier生存图。对Lev治疗的生存率进行了一阶段和两阶段的荟萃分析。结果：在3567份筛选记录中纳入了3篇文章，涵盖825例患者。Lev使用率为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，Lev使用者的中位生存时间为19.2个月（95%CI: 16.4-22.0），而部分/不使用Lev者的中位生存时间为16.5个月（95%CI: 15.2-17.8）（p = 0.006）。单阶段荟萃分析显示，在IDH野生型GB患者中，Lev的使用与生存之间存在显著相关性（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。结论：本荟萃分析强调，Lev可延长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，并确定从Lev治疗中获益最多的亚组。

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

Neurosurgical Review 医学-临床神经学

CiteScore

5.60

自引率

7.10%

发文量

191

审稿时长

6-12 weeks

期刊介绍： The goal of Neurosurgical Review is to provide a forum for comprehensive reviews on current issues in neurosurgery. Each issue contains up to three reviews, reflecting all important aspects of one topic (a disease or a surgical approach). Comments by a panel of experts within the same issue complete the topic. By providing comprehensive coverage of one topic per issue, Neurosurgical Review combines the topicality of professional journals with the indepth treatment of a monograph. Original papers of high quality are also welcome.