John Libbey Eurotext

Epileptic Disorders

The Educational Journal of the International League Against Epilepsy

A common reference-based indirect comparison meta-analysis of intravenous valproate versus intravenous phenobarbitone for convulsive status epilepticus Volume 15, numéro 3, September 2013

Auteurs
Department of Neurological and Movement Sciences. Section of Clinical Neurology, University of Verona, Verona, Department of Neurology, Franz Tappeiner Hospital, Merano, Italy, Federal Teaching Hospital, Abakaliki-Ebonyi State, Nigeria, Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria, Authors contributed equally
  • Mots-clés : clinical trial, randomized controlled, systematic review, meta-analysis, phenobarbitone, status epilepticus, valproic acid
  • DOI : 10.1684/epd.2013.0601
  • Page(s) : 314-23
  • Année de parution : 2013

<p>To compare intravenous valproate (IV-VPA) with intravenous phenobarbitone (IV-PB) in the treatment of established generalised convulsive status epilepticus (GCSE). Efficacy and safety were estimated using a common-reference based indirect comparison meta-analysis (CRBMA) methodology.</p><p>Randomised controlled trials (RCTs) investigating the use of IV-VPA or IV-PB versus intravenous phenytoin (IV-PHT) for GCSE were identified by a systematic search of the literature. A random effects model was used to estimate Mantel-Haenszel odds ratios (ORs) for efficacy and safety of IV-VPA or IV-PB versus IV-PHT in a standard meta-analysis. Adjusted indirect comparisons were then made between VPA and PB using the obtained results.</p><p>CRBMA showed that VPA does not lead to significantly higher seizure cessation (OR 1.00; 95% CI: 0.36-2.76) compared to PB, although it exhibits fewer adverse effects (OR 0.17; 95% CI: 0.04-0.71). Results of this CRBMA are consistent with results of a recently published head-to-head comparison of IV-VPA and IV-PB.</p><p>There is insufficient evidence to demonstrate superiority of IV-VPA over IV-PB for the treatment of GCSE in terms of efficacy. Some direct and indirect comparisons suggest that VPA has a better safety profile than PB. However, the limited numbers of underpowered RCTs included in this meta-analysis are not sufficient to justify a change in clinical practice. More rigorous and appropriately powered RCTs are therefore required to definitively determine the efficacy and tolerability of VPA for the treatment of GCSE.</p>