在中风后发作中的抗药物:系统性审查和网络元分析
Shubham Misra1, Selena Wang2,3, Terence J Quinn4
1Department of Neurology, Yale University School of Medicine, New Haven, CT.
Neurology
|January 14, 2025
概括
莱维他和拉莫特里金似乎是治疗中风后发作的安全抗发作药物,尽管复发率仍然很高. 由于研究的局限性,建议谨慎使用.
科学领域:
- 神经学 神经学
- 药理学 药理学是指药理学的学科.
- 临床研究 临床研究
背景情况:
- 脑卒中后发作 (PSS) 管理需要有效的抗发作药物 (ASM).
- 对于PSS的最佳ASM尚未确立.
- 这项研究评估了PSS患者的ASM疗效和安全性.
研究的目的:
- 为了比较各种ASM对PSS的有效性和安全性.
- 为了识别具有较低发作复发率,不良事件和停药率的ASM.
- 评估与PSS中不同ASM相关的死亡率.
主要方法:
- 在ASM上对PSS患者的电子数据库进行系统的文献搜索.
- 网络元分析使用 levetiracetam 作为参考,评估发作复发,不良事件,停药和死亡率.
- 使用Cochrane和RoBINS-I工具进行偏差风险评估;用GRADE评估证据的确定性.
主要成果:
- 15项研究 (N=18,676) 与13项ASM进行了比较;大多数研究中存在偏差的高风险.
- 氨酸显示出较高的发作复发率和不良事件与 levetiracetam 相比 (非常低的确定性证据).
- 卡巴马泽平和类药物与更高的断药率有关;酸和类药物与更高的死亡率有关 (低至中等至高确定性证据).
- 列维他拉cetam,埃斯利卡巴泽平和拉科萨米德的复发最少;拉莫特里金的不良事件/中止最少,死亡率较低.
结论:
- 列维他和拉莫特里金显示出对PSS的潜在安全性和耐受性.
- 尽管使用ASM,但高发作复发率在PSS人群中仍然存在.
- 由于固有的研究偏见和混因素,研究结果需要谨慎解释.
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