Levetiracetam for epilepsy: an evidence map of efficacy, safety and economic profiles

Zhan-Miao Yi,1–3 Cheng Wen,1,2 Ting Cai,4 Lu Xu,4 Xu-Li Zhong,5 Si-Yan Zhan,4,6 Suo-Di Zhai1,3 1Department of Pharmacy, Peking University Third Hospital, Beijing, China; 2Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University Healt...

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Autores principales:	Yi ZM, Wen C, Cai T, Xu L, Zhong XL, Zhan SY, Zhai SD
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	levetiracetam epilepsy seizure freedom pregnant cognitive functions Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/0bfb3a2437454669aac22f3797b95a0a
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spelling	oai:doaj.org-article:0bfb3a2437454669aac22f3797b95a0a2021-12-02T01:12:55ZLevetiracetam for epilepsy: an evidence map of efficacy, safety and economic profiles1178-2021https://doaj.org/article/0bfb3a2437454669aac22f3797b95a0a2018-12-01T00:00:00Zhttps://www.dovepress.com/levetiracetam-for-epilepsy-an-evidence-map-of-efficacy-safety-and-econ-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Zhan-Miao Yi,1–3 Cheng Wen,1,2 Ting Cai,4 Lu Xu,4 Xu-Li Zhong,5 Si-Yan Zhan,4,6 Suo-Di Zhai1,3 1Department of Pharmacy, Peking University Third Hospital, Beijing, China; 2Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University Health Science Center, Beijing, China; 3Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China; 4Department of Epidemiology and Bio-statistics, School of Public Health, Peking University Health Science Center, Beijing, China; 5Department of Pharmacy, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China; 6Center for Clinical Epidemiology, Peking University Third Hospital, Beijing, China 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 US$ 76.18 per seizure-free day gained in Canada and US$ 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. Registered number: PROSPERO (No CRD 42017069367). Keywords: seizure freedom, responder rate, quality of life, malformations, neurological development, psychiatric side effects, cost-effectivenessYi ZMWen CCai TXu LZhong XLZhan SYZhai SDDove Medical Pressarticlelevetiracetamepilepsyseizure freedompregnantcognitive functionsNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 15, Pp 1-19 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	levetiracetam epilepsy seizure freedom pregnant cognitive functions Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	levetiracetam epilepsy seizure freedom pregnant cognitive functions Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Yi ZM Wen C Cai T Xu L Zhong XL Zhan SY Zhai SD Levetiracetam for epilepsy: an evidence map of efficacy, safety and economic profiles
description	Zhan-Miao Yi,1–3 Cheng Wen,1,2 Ting Cai,4 Lu Xu,4 Xu-Li Zhong,5 Si-Yan Zhan,4,6 Suo-Di Zhai1,3 1Department of Pharmacy, Peking University Third Hospital, Beijing, China; 2Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University Health Science Center, Beijing, China; 3Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China; 4Department of Epidemiology and Bio-statistics, School of Public Health, Peking University Health Science Center, Beijing, China; 5Department of Pharmacy, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China; 6Center for Clinical Epidemiology, Peking University Third Hospital, Beijing, China 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 US$ 76.18 per seizure-free day gained in Canada and US$ 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. Registered number: PROSPERO (No CRD 42017069367). Keywords: seizure freedom, responder rate, quality of life, malformations, neurological development, psychiatric side effects, cost-effectiveness
format	article
author	Yi ZM Wen C Cai T Xu L Zhong XL Zhan SY Zhai SD
author_facet	Yi ZM Wen C Cai T Xu L Zhong XL Zhan SY Zhai SD
author_sort	Yi ZM
title	Levetiracetam for epilepsy: an evidence map of efficacy, safety and economic profiles
title_short	Levetiracetam for epilepsy: an evidence map of efficacy, safety and economic profiles
title_full	Levetiracetam for epilepsy: an evidence map of efficacy, safety and economic profiles
title_fullStr	Levetiracetam for epilepsy: an evidence map of efficacy, safety and economic profiles
title_full_unstemmed	Levetiracetam for epilepsy: an evidence map of efficacy, safety and economic profiles
title_sort	levetiracetam for epilepsy: an evidence map of efficacy, safety and economic profiles
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/0bfb3a2437454669aac22f3797b95a0a
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Levetiracetam for epilepsy: an evidence map of efficacy, safety and economic profiles

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