Intravenous versus intramuscular route of administration of natural adrenocorticotropic hormone in infantile epileptic spasm syndrome.

Abstract

Background: Infantile epileptic spasm syndrome (ISS) is an age-dependent epileptic condition typically emerging within the first year of life, and adrenocorticotropic hormone (ACTH) has been established as a first-line therapeutic drug for the ISS since 1958. However, there is a notable variation in ACTH dosage practices worldwide, with intramuscular injection being common in some countries and intravenous drip preferred in others, including China. This study aimed to identify a preferable administration modality for ACTH-based utilization in treating ISS.

Methods: A retrospective analysis was conducted on 221 ISS patients treated with ACTH via the two administration routes from January 2021 to December 2022. Clinical efficacy and adverse effects were assessed. Health economics were evaluated using a cost-effectiveness ratio, incorporating direct costs and a comprehensive effectiveness indicator.

Results: Intramuscular injection demonstrated a higher effective rate (97.20%) compared to intravenous infusion (80.50%). Adverse effects such as upper respiratory tract infections and diarrhea were significantly less in the intramuscular group. The unit effectiveness cost was significantly lower for intramuscular injection (¥19.53) than for intravenous infusion (¥32.86).

Conclusions: Although both routes of administration were successful in controlling spasms in patients, intramuscular injection of ACTH was deemed economically preferable due to its superior clinical efficacy, less adverse effects, and higher safety profile.