Research Scholar National Institute of Pharmaceutical Education and Research (NIPER), SAS Nagar SAS Nagar, India
Background: Recent guidelines and reviews on Infantile epileptic spasm syndrome (IESS) recommend the use of adrenocorticotropic hormone (ACTH), corticosteroids or vigabatrin, as the first-line treatment. However, there is little unanimity among authors in terms of the best therapeutic approach.
Objectives: To summarize the evidence across systematic reviews (SRs) and meta-analyses (MA) regarding the effectiveness of first line treatment regimen for IESS.
Methods: Databases like PubMed and Embase were manually searched from inception to January 12, 2023 for systematic reviews and meta-analyses comparing first-line IS treatment efficacy. The methodological quality of the included reviews was evaluated using the “Assessing the Methodological Quality of Systematic Reviews (AMSTAR)” and the certainty of evidence of statistically significant outcomes was evaluated using the “Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Estimates and 95% CI of each related outcomes, was calculated using fixed effects models and extracted in the form of odds radio (OR) and I² metric. SRs' findings, without a formal MA, were reported descriptively
Results: Among 133 articles we identified 19 studies for final assessment, published between 2010-2022. AMSTAR shows study quality ranges between “low “to “critically low”. Pooled estimates were recalculated into Odds ratio to maintain homogeneity. As compared between prednisolone vs ACTH for cessation of spasm and resolution of hypsarrhythmia odds ratio is 1.02 (CI:0.42-2.44, I2-71%) & 1.07 (CI:0.54-2.13, I2-71%) respectively. The certainty of evidence ranges between Moderate to Very Low for both the outcome. Outcome certainty for Electroclinical and clinical remission is “Low” Reduction in spasm is Moderate to low and very low for adverse events. Two reviews showed superiority of Prednisolone/ Prednisone over ACTH, 4 studies showed superiority of LD ACTH over HD ACTH few showed no difference in HD Prednisone vs ACTH.
Conclusions: The findings suggest that there may be a small difference in the efficacy of these treatments, but the evidence is not strong enough to draw firm conclusions. The quality of the studies included in the analysis was found to be low to critically low, further highlighting the need for higher-quality studies to inform clinical practice.
