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Leukopenia in Children on Antiseizure Medication is Common and Has Minor Clinical Impact
Hanna Pettersson1, Tamara Alani1, Ingehla Rydén2
1Divison of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Pediatric Pharmaceuticals Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
Insights
Leukopenia, a common side effect of antiseizure medications (ASMs), often occurs mildly in children and typically lacks serious complications. Discontinuation or adjustment of ASMs may not be necessary for mild cases.
Area of Science:
- Pediatric Neurology
- Pharmacovigilance
- Hematology
Background:
- Antiseizure medications (ASMs) are widely used in pediatric populations.
- Leukopenia is a potential side effect of ASMs, but its prevalence and clinical significance in children are not well-established in real-world settings.
Purpose of the Study:
- To determine the real-world prevalence of leukopenia in children treated with ASMs.
- To identify risk factors associated with leukopenia development.
- To evaluate the clinical impact and management of leukopenia in this cohort.
Main Methods:
- Retrospective cohort study of 198 pediatric patients (<18 years) treated with ASMs.
- Data collected from electronic medical records.
- Comparison of patients who developed leukopenia versus those who did not.
Main Results:
- Nearly half (49%) of patients experienced at least one episode of leukopenia.
- Most leukopenia episodes were mild (88%) and asymptomatic, with no life-threatening cases or deaths.
- Risk factors included co-existing organ dysfunction, longer treatment duration, and combination ASM therapy.
Conclusions:
- Leukopenia is a more frequent side effect of ASMs in children than previously reported.
- The majority of ASMs can cause leukopenia, with no significant difference between older and newer agents.
- Mild leukopenia in children on ASMs is often asymptomatic and may not require treatment discontinuation or adjustment.
Objective:
To explore the prevalence, risk factors, and impact of leukopenia among children treated with antiseizure medication (ASM) in a real-world setting.
Study Design:
The most recent 198 pediatric (<18 years) patients treated with ASMs at Astrid Lindgren Children's Hospital were included in a retrospective cohort study. Clinical variables were collected from electronic medical records. Patients who did and did not develop leukopenia were compared.
Results:
Ninety-seven (49%) patients developed at least 1 episode of leukopenia. Most episodes (180 [88%]) were mild (ie, lower normal limit - 3.0 × 109 cells/L) and no patient developed life-threatening leukopenia or died. Clinical actions (ie, ASM switch or tapering) were taken in only 9 (4%) episodes of leukopenia. The clinical impact was leukopenia symptoms in 7 (3%) episodes, and other blood cell cytopenias more frequently (62% vs 18%; P < .001) compared with children without leukopenia. The risk factors for developing leukopenia were dysfunction in other organ systems (eg, endocrinologic disorders, heart disease, or kidney disease), longer treatment duration, ASM combination treatments, and slightly older age (mean 11 vs 9 years, P = .03). Leukopenia was seen in treatments with almost all ASMs (ie, substances) with only a few significant differences between the groups. There was no difference in leukopenia incidence between older vs newer ASMs.
Conclusions:
Leukopenia is a far more common side-effect of ASMs than earlier described. However, this leukopenia is mostly asymptomatic and without complications. If mild leukopenia occurs, ASM discontinuation or adjustment may not be necessary.
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