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Neuropediatrics 2025; 56(02): 102-110
DOI: 10.1055/a-2517-7800
Original Article

Adrenocorticotropic Hormone versus Prednisolone for Infantile Epileptic Spasms Syndrome: A Systematic Review and Economic Evaluation

Ruonan Gao 
1   Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University; Children's Medicine Key Laboratory of Sichuan Province, Chengdu, China
2   NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
3   Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
4   West China School of Medicine, Sichuan University, Chengdu, China
,
Xiao Cheng
1   Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University; Children's Medicine Key Laboratory of Sichuan Province, Chengdu, China
2   NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
3   Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
,
Liang Huang 
1   Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University; Children's Medicine Key Laboratory of Sichuan Province, Chengdu, China
2   NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
3   Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
,
Rong Luo
3   Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
5   Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
,
Linan Zeng
1   Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University; Children's Medicine Key Laboratory of Sichuan Province, Chengdu, China
2   NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
3   Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
,
Guo Cheng
3   Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
5   Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
6   Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Sichuan University, Chengdu, China
,
Qin Yu
3   Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
7   National Drug Clinical Trial Institute, West China Second University Hospital, Sichuan University, Chengdu, China
,
Hailong Li
1   Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University; Children's Medicine Key Laboratory of Sichuan Province, Chengdu, China
2   NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
3   Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
,
Lingli Zhang
1   Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University; Children's Medicine Key Laboratory of Sichuan Province, Chengdu, China
2   NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
3   Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
8   Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
› Institutsangaben
Funding This work was supported by funds from the National Natural Science Foundation for Young Scholars of China (72004151) and the Sichuan Natural Science Foundation Youth Fund Project (23NSFSC4810).
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Abstract

Background Infantile epileptic spasms syndrome (IESS) is the most common epileptic encephalopathy in infancy and early childhood. At present, adrenocorticotropic hormone (ACTH) and prednisolone are commonly used as drug treatment regimens for IESS. However, evidence of efficacy and economics remains controversial. This study aimed to evaluate the effectiveness, safety, and economy of ACTH and prednisolone of IESS.

Methods Seven literature databases and two clinical trial registration platforms were searched, and a meta-analysis was conducted. From the perspective of the health care system, a 14-day economic evaluation was conducted. The rate of spasm cessation on the 14th day was used as the effect index. The univariate sensitivity analysis was used to verify the robustness of the results.

Results Nine randomized controlled trials (RCTs) were included. Current clinical evidence is not sufficient to prove the difference in the rate of spasm cessation on the 14th day (risk ratio [RR] = 1.05, 95% CI 0.86–1.27, p = 0.64) and total adverse event rate (RR = 0.87, 95% CI 0.53–1.42, p = 0.57). ACTH had an advantage in improving electroclinical response on the 14th day (RR = 1.46, 95% CI 1.09–1.96, p = 0.01) and reducing the number of months taken for relapse (mean difference = 1.65, 95% CI 1.01–2.29, p < 0.01). The cost of ACTH and prednisolone was 5,629.19 yuan and 5.56 yuan, respectively. Univariate sensitivity analysis showed the most influential factor was the cost of ACTH.

Conclusions There is insufficient evidence to determine whether ACTH or prednisolone is better in the short-term regimen of IESS. ACTH may have more advantages in improving the long-term outcome of IESS. In China, a prednisolone regimen of IESS has a lower cost within 14 days.

Keywords

infantile epileptic spasms syndrome - adrenocorticotropic hormone - prednisolone - meta-analysis - cost-minimization analysis

Supplementary Material



Publikationsverlauf

Eingereicht: 27. Oktober 2024

Angenommen: 15. Januar 2025

Artikel online veröffentlicht:
03. Februar 2025

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