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A meta-analysis of randomized controlled trials on levetiracetam in the treatment of pediatric patients with epilepsy

Authors Zhang LL, Wang CZ, Li W

Received 11 September 2017

Accepted for publication 2 February 2018

Published 14 March 2018 Volume 2018:14 Pages 769—779

DOI https://doi.org/10.2147/NDT.S151413

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 3

Editor who approved publication: Professor Wai Kwong Tang


Lanlan Zhang,1 Chengzhong Wang,1 Wei Li2

1Department of Pediatric Neurology, Yancheng Maternal and Child Health Hospital, 2Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China

Objective: To evaluate clinical efficacy, safety, and tolerability of levetiracetam as mono- or adjunctive therapy in the treatment of children and adolescents with epilepsy.
Materials and methods: We performed a meta-analysis of randomized controlled trials published from January 2007 to December 2016 in the databases Web of Science, Medline, Embase, Cochrane Library, and PubMed, Bing, Baidu, Google Scholar, Chinese National Knowledge Infrastructure (CNKI), and Wanfang Data. All of the studies eligible were compared for the efficacy, safety, and tolerability of levetiracetam with other antiepileptic drugs (AEDs) in epilepsy.
Results: Thirteen randomized controlled trials on a total of 1,013 patients met the inclusion criteria in present study. Compared with other AEDs (oxcarbazepine, valproate, sulthiame, carbamazepine, and placebo), we found that levetiracetam had a comparable seizure-free rate (RR 1.16, 95% CI 1.03–1.31; P=0.30). Regarding seizure-frequency reduction ≥50% from baseline, levetiracetam also seemed equivalent to other AEDs (RR 1.08, 95% CI 1.01–1.16; P=0.35). In spite of patients treated with levetiracetam having a lower incidence of side effects compared with patients treated with other AEDs (RR 0.90, 95% CI 0.77–1.06), the difference between them was minute and not statistically significant (P=0.22).
Conclusion: Based on this meta-analysis, it seemed that levetiracetam had comparable effects concerning efficacy, tolerability, and adverse events. Nevertheless, 13 studies were insufficient to draw a conclusion that levetiracetam is effective as mono- and adjunctive therapy for all types of epilepsy syndromes and seizures. Larger-sample and more well-designed trials are needed to justify the widespread use of levetiracetam in the treatment of children and adolescents.

Keywords: levetiracetam, epilepsy, children, antiepileptic drug, RCT, efficacy

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