Shaojun Li1,2,3,4,5, Xuefei Zhong2,3,4,5,6, Siqi Hong2,3,4,5,7, Tingsong Li2,3,4,5,7, Li Jiang2,3,4,5,7. 1. Department of Emergency, Children's Hospital of Chongqing Medical University, Chongqing, China. 2. Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China. 3. National Clinical Research Center for Child Health and Disorders (Chongqing), Children's Hospital of Chongqing Medical University, Chongqing, China. 4. China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China. 5. Chongqing Key Laboratory of Paediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China. 6. Department of Electroneurophysiology, Children's Hospital of Chongqing Medical University, Chongqing, China. 7. Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China.
Abstract
AIM: To compare the efficacy and safety of prednisolone/prednisone and adrenocorticotropic hormone (ACTH) in the treatment of infantile spasms using a meta-analysis of randomized controlled trials (RCTs). METHOD: In a systematic literature search of electronic databases (MEDLINE, Embase, the Cochrane Library), we identified RCTs that assessed prednisolone/prednisone compared with ACTH/tetracosactide in patients with infantile spasms. The electroclinical response and adverse events were evaluated. RESULTS: Six RCTs (616 participants) were included in the meta-analysis. Compared with prednisolone/prednisone, ACTH/tetracosactide was not superior in terms of cessation of spasms at day 14 (relative risk 1.19, 95% confidence interval [CI] 0.74-1.92), day 42 (relative risk 1.02, 95% CI 0.63-1.65), and resolution of hypsarrhythmia on electroencephalogram (relative risk 1.14, 95% CI 0.71-1.81); the incidences of common adverse reactions caused by ACTH/tetracosactide were not lower than that of prednisolone/prednisone for irritability (relative risk 0.79, 95% CI 0.57-1.10), increased appetite (relative risk 0.78, 95% CI 0.57-1.08), weight gain (relative risk 0.86, 95% CI 0.56-1.32), and gastrointestinal upset (relative risk 0.60, 95% CI 0.35-1.02), though it seemed less frequent. INTERPRETATION: Prednisolone/prednisone elicits a similar electroclinical response as ACTH for infantile spasms, which indicates that it can be an alternative to ACTH for treating infantile spasms. What this paper adds Prednisolone/prednisone is as effective as adrenocorticotropic hormone (ACTH) in electroclinical response of infantile spasms. Prednisolone/prednisone and ACTH cause similar and tolerable adverse effects, whose incidences are comparable. High-dose prednisone/prednisolone might be preferable to low dose for achieving freedom from spasms.
AIM: To compare the efficacy and safety of prednisolone/prednisone and adrenocorticotropic hormone (ACTH) in the treatment of infantile spasms using a meta-analysis of randomized controlled trials (RCTs). METHOD: In a systematic literature search of electronic databases (MEDLINE, Embase, the Cochrane Library), we identified RCTs that assessed prednisolone/prednisone compared with ACTH/tetracosactide in patients with infantile spasms. The electroclinical response and adverse events were evaluated. RESULTS: Six RCTs (616 participants) were included in the meta-analysis. Compared with prednisolone/prednisone, ACTH/tetracosactide was not superior in terms of cessation of spasms at day 14 (relative risk 1.19, 95% confidence interval [CI] 0.74-1.92), day 42 (relative risk 1.02, 95% CI 0.63-1.65), and resolution of hypsarrhythmia on electroencephalogram (relative risk 1.14, 95% CI 0.71-1.81); the incidences of common adverse reactions caused by ACTH/tetracosactide were not lower than that of prednisolone/prednisone for irritability (relative risk 0.79, 95% CI 0.57-1.10), increased appetite (relative risk 0.78, 95% CI 0.57-1.08), weight gain (relative risk 0.86, 95% CI 0.56-1.32), and gastrointestinal upset (relative risk 0.60, 95% CI 0.35-1.02), though it seemed less frequent. INTERPRETATION:Prednisolone/prednisone elicits a similar electroclinical response as ACTH for infantile spasms, which indicates that it can be an alternative to ACTH for treating infantile spasms. What this paper adds Prednisolone/prednisone is as effective as adrenocorticotropic hormone (ACTH) in electroclinical response of infantile spasms. Prednisolone/prednisone and ACTH cause similar and tolerable adverse effects, whose incidences are comparable. High-dose prednisone/prednisolone might be preferable to low dose for achieving freedom from spasms.
Authors: Zachary M Grinspan; John R Mytinger; Fiona M Baumer; Michael A Ciliberto; Bruce H Cohen; Dennis J Dlugos; Chellamani Harini; Shaun A Hussain; Sucheta M Joshi; Cynthia G Keator; Kelly G Knupp; Patricia E McGoldrick; Katherine C Nickels; Jun T Park; Archana Pasupuleti; Anup D Patel; Asim M Shahid; Renee A Shellhaas; Daniel W Shrey; Rani K Singh; Steven M Wolf; Elissa G Yozawitz; Christopher J Yuskaitis; Jeff L Waugh; Phillip L Pearl Journal: J Child Neurol Date: 2020-06-23 Impact factor: 1.987
Authors: Zachary M Grinspan; Kelly G Knupp; Anup D Patel; Elissa G Yozawitz; Courtney J Wusthoff; Elaine Wirrell; Ignacio Valencia; Nilika S Singhal; Douglas R Nordli; John R Mytinger; Wendy Mitchell; Cynthia G Keator; Tobias Loddenkemper; Shaun A Hussain; Chellamani Harini; William D Gaillard; Ivan S Fernandez; Jason Coryell; Catherine J Chu; Anne T Berg; Renee A Shellhaas Journal: Neurology Date: 2021-07-15 Impact factor: 11.800