| Title | Levetiracetam for epilepsy: an evidence map of efficacy, safety and economic profiles |
| Authors | Yi, Zhan-Miao Wen, Cheng Cai, Ting Xu, Lu Zhong, Xu-Li Zhan, Si-Yan Zhai, Suo-Di |
| Affiliation | Peking Univ Third Hosp, Dept Pharm, 49 North Garden Rd, Beijing 100191, Peoples R China Peking Univ, Hlth Sci Ctr, Sch Pharmaceut Sci, Dept Pharm Adm & Clin Pharm, Beijing, Peoples R China Peking Univ, Hlth Sci Ctr, Inst Drug Evaluat, Beijing, Peoples R China Peking Univ, Hlth Sci Ctr, Sch Publ Hlth, Dept Epidemiol & Biostat, Beijing, Peoples R China Childrens Hosp, Capital Inst Pediat, Dept Pharm, Beijing, Peoples R China Peking Univ Third Hosp, Ctr Clin Epidemiol, Beijing, Peoples R China |
| Keywords | seizure freedom responder rate quality of life malformations neurological development psychiatric side effects cost-effectiveness |
| Issue Date | 2019 |
| Publisher | NEUROPSYCHIATRIC DISEASE AND TREATMENT |
| Abstract | Objective: To evaluate the efficacy, safety and economics of levetiracetam (LEV) for epilepsy. Materials and methods: PubMed, Scopus, the Cochrane Library, OpenGrey.eu and ClinicalTrials.gov were searched for systematic reviews (SRs), meta-analyses, randomized controlled trials (RCTs), observational studies, case reports and economic studies published from January 2007 to April 2018. We used a bubble plot to graphically display information of included studies and conducted meta-analyses to quantitatively synthesize the evidence. Results: A total of 14,803 records were obtained. We included 30 SRs/meta-analyses, 34 RCTs, 18 observational studies, 58 case reports and 2 economic studies after the screening process. The included SRs enrolled patients with pediatric epilepsy, epilepsy in pregnancy, focal epilepsy, generalized epilepsy and refractory focal epilepsy. Meta-analysis of the included RCTs indicated that LEV was as effective as carbamazepine (CBZ; treatment for 6 months: 58.9% vs 64.8%, OR=0.76, 95% CI: 0.50-1.16; 12 months: 54.9% vs 55.5%, OR=1.24, 95% CI: 0.79-1.93), oxcarbazepine (57.7% vs 59.8%, OR=1.34, 95% CI: 0.34-5.23), phenobarbital (50.0% vs 50.9%, OR=1.20, 95% CI: 0.51-2.82) and lamotrigine (LTG; 61.5% vs 57.7%, OR=1.22, 95% CI: 0.90-1.66). SRs and observational studies indicated a low malformation rate and intrauterine death rate for pregnant women, as well as low risk of cognitive side effects. But psychiatric and behavioral side effects could not be ruled out. LEV decreased discontinuation due to adverse events compared with CBZ (OR=0.52, 95% CI: 0.41-0.65), while no difference was found when LEV was compared with placebo and LTG. Two cost-effectiveness evaluations for refractory epilepsy with decision-tree model showed USS 76.18 per seizure-free day gained in Canada and USS 44 per seizure-free day gained in Korea. Conclusion: LEV is as effective as CBZ, oxcarbazepine, phenobarbital and LTG and has an advantage for pregnant women and in cognitive functions. Limited evidence supports its cost-effectiveness. |
| URI | http://hdl.handle.net/20.500.11897/552398 |
| DOI | 10.2147/NDT.S181886 |
| Indexed | SCI(E) |
| Appears in Collections: | 第三医院 |
