PMID- 35222241
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220502
IS  - 1664-2295 (Print)
IS  - 1664-2295 (Electronic)
IS  - 1664-2295 (Linking)
VI  - 13
DP  - 2022
TI  - Hormonal Therapy for Infantile Spasms: A Systematic Review and Meta-Analysis.
PG  - 772333
LID - 10.3389/fneur.2022.772333 [doi]
LID - 772333
AB  - OBJECTIVE: The limitations of adrenocorticotrophic hormone (ACTH) treatment for 
      infantile spasms (ISs), such as high costs, limited availability, and adverse 
      effects (AEs), make it necessary to explore whether corticosteroids are optimal 
      alternatives. Many other compelling treatments have gone through trials due to 
      the suboptimal effectiveness of hormonal therapy. A systematic review and 
      meta-analysis were performed to evaluate the effectiveness and safety of hormonal 
      therapy for patients with ISs. METHODS: EMBASE, Ovid MEDLINE, Cochrane Central 
      Register of Controlled Trials (CENTRAL), and online registers were searched 
      through April 2021 for randomized controlled trials (RCTs). RESULTS: A total of 
      19 RCTs (N = 1,279) were included. There was no significant difference in the 
      effectiveness of oral corticosteroids and ACTH in electro-clinical response (risk 
      ratio [RR] = 0.85, 95% CI 0.41-1.76). Low-dose ACTH had similar effectiveness in 
      electro-clinical response compared to usual-dose group (RR = 0.94, 95% CI 
      0.60-1.47) but conferred a lower risk of AEs (RR = 1.71, 95% CI 1.08-2.71). ACTH 
      was more beneficial in controlling spasms than vigabatrin (VGB) (RR = 1.31, 95% 
      CI 1.05-1.64) for patients without tuberous sclerosis complex (TSC). All RCTs 
      were connected through network meta-analysis, and we found that ketogenic diet 
      (KD), zonisamide, methylprednisolone, or combined treatment of hormonal therapy 
      with topiramate (TPM) or pyridoxine was not different in electro-clinical 
      response compared to usual-dose ACTH. CONCLUSION: Our analysis showed that oral 
      corticosteroids could be optional alternatives when ACTH is not applicable, and 
      ACTH is more beneficial for patients without TSC. Moreover, low-dose ACTH is 
      recommended due to comparative effectiveness but lower risk of AEs. However, due 
      to the high heterogeneity of included patients and treatment protocols, these 
      results must be interpreted with caution. RCTs with multicentric involvement and 
      larger sample size are needed for solid evaluation of other alternative 
      treatments.
CI  - Copyright (c) 2022 Guang, Mao, Zhong, Liu, Pan, Yin and Peng.
FAU - Guang, Shiqi
AU  - Guang S
AD  - Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, 
      China.
FAU - Mao, Leilei
AU  - Mao L
AD  - Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, 
      China.
FAU - Zhong, Linxiu
AU  - Zhong L
AD  - Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, 
      China.
FAU - Liu, Fangyun
AU  - Liu F
AD  - Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, 
      China.
FAU - Pan, Zou
AU  - Pan Z
AD  - Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, 
      China.
FAU - Yin, Fei
AU  - Yin F
AD  - Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, 
      China.
FAU - Peng, Jing
AU  - Peng J
AD  - Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, 
      China.
LA  - eng
PT  - Systematic Review
DEP - 20220210
PL  - Switzerland
TA  - Front Neurol
JT  - Frontiers in neurology
JID - 101546899
PMC - PMC8867209
OTO - NOTNLM
OT  - ACTH
OT  - corticosteroids
OT  - hormonal therapy
OT  - infantile spasms
OT  - west syndrome
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2022/03/01 06:00
MHDA- 2022/03/01 06:01
PMCR- 2022/02/10
CRDT- 2022/02/28 05:33
PHST- 2021/09/08 00:00 [received]
PHST- 2022/01/06 00:00 [accepted]
PHST- 2022/02/28 05:33 [entrez]
PHST- 2022/03/01 06:00 [pubmed]
PHST- 2022/03/01 06:01 [medline]
PHST- 2022/02/10 00:00 [pmc-release]
AID - 10.3389/fneur.2022.772333 [doi]
PST - epublish
SO  - Front Neurol. 2022 Feb 10;13:772333. doi: 10.3389/fneur.2022.772333. eCollection 
      2022.