THE EFFECTIVENESS OF ANTIEPILEPTIC MEDICATIONS AS PROPHYLAXIS OF EARLY SEIZURE IN TRAUMATIC BRAIN INJURY PATIENTS COMPARED TO PLACEBO OR NO TREATMENT- A SYSTEMATIC REVIEW AND META-ANALYSIS
Author(s)
Wat R1, Mammi M2, Paredes J3, Haines J3, Alasmari M3, Liew A4, Lu VM2, Arnaout O2, Smith TR2, Gormley WB2, Aglio LS2, Mekary DR3, Zaidi H2
1MCPHS University, Quincy, MA, USA, 2Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, 3MCPHS University, Boston, MA, USA, 4National University of Ireland Galway, Galway, Ireland
OBJECTIVES: The purpose of this study was to quantify the association between the use of prophylactic AEDs, particularly of the four main drugs of interest (phenytoin, levetiracetam, valproate, or carbamazepine) versus placebo or no treatment, and risk of early seizures following TBI. METHODS: A comprehensive search was performed on PubMed, Embase, Cochrane Library, and ClinicalTrials.gov. The selection criteria were English written randomized controlled trials (RCTs) and observational studies, comparing AEDs with placebo or no treatment, for prevention of early PTS. Random-effects models were used to calculate pooled relative risk (RR). Subgroup analysis and meta-regression were used to assess heterogeneity sources. RESULTS: This research included three RCTs (750 patients) and six observational studies (3,362 patients), analyzing the efficacy of phenytoin, levetiracetam, and valproate. The pooled RR estimate across RCTs trended towards a protective effect (RR=0.50; 95% CI 0.24-1.03; I2=59.5%); a significant protective association was demonstrated when pooling the results across all six observational studies (RR=0.43; 95% CI 0.26-0.71; I2= 0%). When stratifying the observational studies by drug, no significant difference was observed (P-interaction=0.85). Begg’s and Egger’s tests indicated no publication bias among observational studies. CONCLUSIONS: Only modest evidence suggested effectiveness of AEDs as prophylaxis of early PTS. Phenytoin was the most studied drug; more prospective studies are needed to assess the efficacy of other AEDs.
Conference/Value in Health Info
2019-05, ISPOR 2019, New Orleans, LA, USA
Value in Health, Volume 22, Issue S1 (2019 May)
Code
PND4
Topic
Clinical Outcomes, Epidemiology & Public Health, Health Service Delivery & Process of Care
Topic Subcategory
Comparative Effectiveness or Efficacy, Disease Management, Safety & Pharmacoepidemiology
Disease
Drugs, Injury and Trauma, Neurological Disorders