Levetiracetam versus Phenytoin for the Pharmacotherapy of Benzodiazepine-Refractory Status Epilepticus: A Systematic Rev
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SYSTEMATIC REVIEW
Levetiracetam versus Phenytoin for the Pharmacotherapy of Benzodiazepine‑Refractory Status Epilepticus: A Systematic Review and Meta‑Analysis of Randomized Controlled Trials Tao Xue1 · Luxin Wei2 · Xiaotian Shen3 · Zilan Wang1 · Zhouqing Chen1 · Zhong Wang1 Accepted: 1 October 2020 © Springer Nature Switzerland AG 2020
Abstract Background Recent studies have shown conflicting results regarding the effectiveness of levetiracetam for treating benzodiazepine-refractory status epilepticus (SE) compared with phenytoin. Therefore, a meta-analysis was carried out to assess the value of levetiracetam versus phenytoin in the pharmacotherapy of benzodiazepine-refractory SE. Objective The aim of this systematic review and meta-analysis was to compare the efficacy and safety of levetiracetam and phenytoin in the treatment of benzodiazepine-refractory SE. Methods The MEDLINE, EMBASE, CENTRAL and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs) that had been conducted to evaluate levetiracetam versus phenytoin for benzodiazepine-refractory SE, to April 2020. The data were assessed using Review Manager 5.3 software. The risk ratio (RR) was analyzed using dichotomous outcomes, and calculated using a random-effect model. Results We pooled 1850 patients from 12 RCTs. Patients in the levetiracetam group had a significantly higher rate of clinical seizure cessation than in the phenytoin group (75.2% vs. 67.8%; RR 1.14, 95% confidence interval [CI] 1.05–1.25, p = 0.003). Moreover, less adverse events were observed in the levetiracetam group than in the phenytoin group (17.8% vs. 21.4%; RR 0.82, 95% CI 0.70–0.97, p = 0.02). In subgroup analysis, clinical seizure cessation was achieved more frequently with a higher dose of levetiracetam (> 30 mg/kg) [RR 1.15, 95% CI 1.00–1.32, p = 0.05]. Furthermore, in the subgroup of children, levetiracetam showed a higher rate of clinical seizure cessation than phenytoin (RR 1.13, 95% CI 1.02–1.25, p = 0.02). Conclusion Pharmacotherapy for BZD-refractory SE by LEV is superior to PHT in efficacy and safety outcomes.
Tao Xue and Luxin Wei have contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40263-020-00770-0) contains supplementary material, which is available to authorized users. * Zhouqing Chen [email protected]
Zilan Wang [email protected]
* Zhong Wang [email protected]
1
Tao Xue [email protected]
Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu, China
2
Luxin Wei [email protected]
Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu, China
3
Shanghai Medical College, Fudan University, Shanghai 200032, China
Xiaotian Shen [email protected]
Vol.:(0123456789)
T. Xue et al.
Key Points From the perspective of efficacy and safety outcomes, levetiracetam was superior to phen
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