Effectiveness of corticosteroids versus adrenocorticotropic hormone for infantile spasms: a systematic review and meta‐analysis

Annals of Clinical and Translational Neurology - Tập 6 Số 11 - Trang 2270-2281 - 2019
Yin‐Hsi Chang1, Chiehfeng Chen2,3,4, Shu‐Huey Chen5,6,7, Shen Yuchun1, Yung‐Ting Kuo5,6
1School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
2Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
3Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
4Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
5Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
6Department of Pediatrics Shuang Ho Hospital, Ministry of Health and Welfare Taipei Medical University New Taipei City Taiwan
7Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan

Tóm tắt

AbstractObjectiveTo compare the therapeutic effectiveness of oral corticosteroids with that of adrenocorticotrophic hormone for infantile spasms.MethodsPubMed, Embase, Scopus, and the Cochrane library were searched to retrieve studies published before December 2018 to identify pediatric patients with a diagnosis of infantile spasms. The interventions of oral corticosteroids and adrenocorticotrophic hormone were compared. We included only randomized controlled trials that reported the cessation of spasms as treatment response. The primary outcome was clinical spasm cessation on day 13 or 14. The secondary outcomes were the resolution of hypsarrhythmia, side effects, continued spasm control, spasm relapse rate, and subsequent epilepsy rate. Following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses, the study‐level quality assessment was conducted using the Cochrane risk‐of‐bias tool.ResultsAfter extensive review, 39 articles were included for meticulous evaluation. Five randomized controlled trials with a total of 239 individuals were eligible for further analysis. No significant difference was detected between the corticosteroids and adrenocorticotrophic hormone in the cessation of clinical spasms (odds ratio [OR]: 0.54; 95% confidence interval [CI]: 0.16 to 1.81; P = 0.32). The subgroups of high‐dose prednisolone versus adrenocorticotrophic hormone and low‐dose prednisone versus adrenocorticotrophic hormone also exhibited no significant difference. Furthermore, the two subgroups did not differ in terms of hypsarrhythmia resolution, side effects, relapse rate, or subsequent epilepsy rate.InterpretationThis meta‐analysis suggests that high‐dose prednisolone is not inferior to adrenocorticotrophic hormone and that it be considered a safe and effective alternative treatment.

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Annals of Clinical and Translational Neurology

Tập 6 Số 11

2270-2281

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