Corticotherapy versus adrenocorticotropic hormone for treating West syndrome: a systematic review and meta-analysis

Although it is known that the most commonly used therapies for West syndrome (WS) are intramuscular adrenocorticotropic hormone (ACTH) and oral prednisolone, there is still controversy in the literature regarding the equivalence of their effects.We aimed to present an updated review comparing the therapeutic and adverse effects of ACTH therapy versus corticosteroids in children with West syndrome (WS).The PubMed, EMBASE, and Cochrane Central databases were searched. The outcomes of interest selected were spasm cessation on day 14 of therapy, cessation of hypsarrhythmia and adverse effects such as weight gain, infection, irritability, and hypertension. Studies were reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and a meta-analysis was performed. We compared the results using the risk ratio (RR) and odds ratio (OR). for the binary outcomes, with 95% confidence intervals (CI) and a random-effects model. Statistical analysis was performed using RevMan 5.1.7.Compared with corticoids, ACTH was associated with a significant increase in weight (RR: 1.41; 95% CI: 1.01-1.97; p = 0.04). There was no significant difference in cessation of spasms on day 14 (OR: 0.91; 95% CI: 0.47-1.47; p = 0.79), hypsarrhythmia (OR: 0.97; 95% CI: 0.22-4.34), irritability (RR: 0.78; 95% CI: 0.30-1.99), hypertension (RR: 0.64; 95% CI: 0.35-1.15; p = 0.14), and infection (RR: 0.69; 95% CI: 0.19-2.50; p = 0.57).This study provides robust evidence regarding the safety and efficacy of ACTH or corticoids in children with WS. However, the significant heterogeneity between studies restricts the analysis, emphasizing the need for additional research to assess the best WS treatment option.