PMID- 34053822 OWN - NLM STAT- MEDLINE DCOM- 20210719 LR - 20210719 IS - 1532-2653 (Electronic) IS - 0967-5868 (Linking) VI - 89 DP - 2021 Jul TI - Comparison of the efficacy and safety of levetiracetam and phenytoin in the treatment of established status epilepticus: A systematic review and meta-analysis. PG - 422-429 LID - S0967-5868(21)00211-3 [pii] LID - 10.1016/j.jocn.2021.05.004 [doi] AB - Status epilepticus (SE) is the second most critical neurological illness after cerebrovascular disease. Phenytoin has traditionally been considered the second-line drug of first choice after failure of first-line treatment using benzodiazepines. In recent years, levetiracetam has been proposed as a potential substitute for phenytoin. To comprehensively evaluate the efficacy and safety of levetiracetam and phenytoin in the treatment of patients with established SE, we integrated the data from 11 eligible studies and conducted a systematic review and meta-analysis. The PubMed, Web of Science, Cochrane Library, and Embase databases were searched to identify eligible articles reporting outcomes including clinical seizure cessation within 60 min, clinical recurrence rate within 24 h, good final outcome at discharge, and adverse events (AEs) of treatment with levetiracetam and phenytoin. Our study included a total of 11 trials including a total of 1933 patients. The outcomes showed that the pooled Risk Raito (RR) of clinical seizure cessation within 60 min was 1.08 (95% CI = 1.02-1.14, P = 0.01). The pooled RR of clinical recurrence rate within 24 h was 1.03 (95% CI = 0.66-1.59, P = 0.91). The pooled RR of AEs was 0.83 (95% CI = 0.57-1.21, P = 0.34). The pooled RRs of life-threatening hypotension and acute respiratory depression were 0.29 (95% CI = 0.10-0.81, P = 0.02) and 0.63 (95% CI = 0.40-0.98, P = 0.04), respectively. Levetiracetam might be more effective than phenytoin for the treatment of established SE and is associated with a lower incidence of more serious AEs. Levetiracetam can be used as an alternative to phenytoin for the treatment of benzodiazepine-refractory SE. CI - Copyright (c) 2021. Published by Elsevier Ltd. FAU - Yang, Li AU - Yang L AD - Department of Pharmacy, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing Engineering Research Center for Nervous System Drugs, Beijing Institute for Brain Disorders, Key Laboratory for Neurodegenerative Diseases of Ministry of Education, Beijing 100053, China; College of Pharmacy, Zunyi Medical University, Zunyi 563000, China. FAU - Dong, Xian-Zhe AU - Dong XZ AD - Department of Pharmacy, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing Engineering Research Center for Nervous System Drugs, Beijing Institute for Brain Disorders, Key Laboratory for Neurodegenerative Diseases of Ministry of Education, Beijing 100053, China. FAU - Cui, Xiao-Hui AU - Cui XH AD - Department of Pharmacy, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing Engineering Research Center for Nervous System Drugs, Beijing Institute for Brain Disorders, Key Laboratory for Neurodegenerative Diseases of Ministry of Education, Beijing 100053, China. FAU - Liu, Jia-Ming AU - Liu JM AD - Department of Pharmacy, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing Engineering Research Center for Nervous System Drugs, Beijing Institute for Brain Disorders, Key Laboratory for Neurodegenerative Diseases of Ministry of Education, Beijing 100053, China. FAU - Liu, Wen-Na AU - Liu WN AD - Department of Pharmacy, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing Engineering Research Center for Nervous System Drugs, Beijing Institute for Brain Disorders, Key Laboratory for Neurodegenerative Diseases of Ministry of Education, Beijing 100053, China. FAU - Zhang, Lan AU - Zhang L AD - Department of Pharmacy, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing Engineering Research Center for Nervous System Drugs, Beijing Institute for Brain Disorders, Key Laboratory for Neurodegenerative Diseases of Ministry of Education, Beijing 100053, China. Electronic address: xwzhanglan@126.com. LA - eng PT - Comparative Study PT - Journal Article PT - Meta-Analysis PT - Systematic Review DEP - 20210527 PL - Scotland TA - J Clin Neurosci JT - Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia JID - 9433352 RN - 0 (Anticonvulsants) RN - 44YRR34555 (Levetiracetam) RN - 6158TKW0C5 (Phenytoin) SB - IM MH - Anticonvulsants/*adverse effects/therapeutic use MH - Humans MH - Levetiracetam/*adverse effects/therapeutic use MH - Phenytoin/*adverse effects/therapeutic use MH - Status Epilepticus/*drug therapy OTO - NOTNLM OT - Levetiracetam OT - Meta-analysis OT - Phenytoin OT - Status epilepticus COIS- Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2021/06/01 06:00 MHDA- 2021/07/20 06:00 CRDT- 2021/05/31 05:52 PHST- 2020/12/07 00:00 [received] PHST- 2021/04/21 00:00 [revised] PHST- 2021/05/02 00:00 [accepted] PHST- 2021/06/01 06:00 [pubmed] PHST- 2021/07/20 06:00 [medline] PHST- 2021/05/31 05:52 [entrez] AID - S0967-5868(21)00211-3 [pii] AID - 10.1016/j.jocn.2021.05.004 [doi] PST - ppublish SO - J Clin Neurosci. 2021 Jul;89:422-429. doi: 10.1016/j.jocn.2021.05.004. Epub 2021 May 27.