Antiepileptic Drugs (AED)

    Comparative safety of antiepileptic drugs for neurological development in children exposed during pregnancy and breast feeding: a systematic review and network meta-analysis

    Veroniki AA, Rios P, Cogo E, Straus SE, Finkelstein Y, Kealey R, Reynen E, Soobiah C, Thavorn K, Hutton B, Hemmelgarn BR, Yazdi F, D'Souza J, MacDonald H, Tricco AC. Comparative safety of antiepileptic drugs for neurological development in children exposed during pregnancy and breast feeding: a systematic review and network meta-analysis. BMJ Open. 2017;7(7):e017248. DOI: 10.1136/bmjopen-2017-017248

     

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    Bottom Line:

    • In comparison to children not exposed to anti-epileptic drugs in utero, children exposed to anti-epileptic drugs are at increased risk for adverse neurodevelopmental outcomes. In particular, the agent valproate, both alone and when combined with another anti-epileptic drug, was associated with the greatest odds of adverse neurodevelopmental outcomes, when compared to control
    • The use of oxcarbazepine and lamotrigine were associated with increased odds of developing autism

    Impact:

    • Our results can be used by patients and physicians to tailor administration of these agents
    • Provided Health Canada with evidence on the safety of these agents for their decision-making
    • Featured in a media article targeting epileptic patients and physicians

    Canadian Institutes of Health Research (CIHR)/ Drug Safety and Effectiveness Network (DSEN)


    Comparative safety of anti-epileptic drugs during pregnancy: a systematic review and network meta-analysis of congenital malformations and prenatal outcomes

    Veroniki AA, Cogo E, Rios P, Straus SE, Finkelstein Y, Kealey R, Reynen E, Soobiah C, Thavorn K, Hutton B. Comparative safety of anti-epileptic drugs during pregnancy: a systematic review and network meta-analysis of congenital malformations and prenatal outcomes. BMC medicine. 2017;15(1):95. DOI: 10.1186/s12916-017-0845-1

     

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    Bottom Line:

    • Anti-epileptic drugs associated with increased risk for two or more types of congenital malformations  included: carbamazepine, ethosuximide, gabapentin, phenobarbital, phenytoin, topiramate, and valproate
    • In comparison to children not exposed to anti-epileptic drugs in utero, children whose mothers used newer-generation agents (e.g., lamotrigine and levetiracetam), were not at increased risk for congenital malformations. The aforementioned children were also less likely to experience cardiac malformations. However, this does not mean these agents are not harmful to children in utero, as the low quality of available studies suggests that these findings be interpreted with caution

    Impact:

    • Our results can be used by patients and physicians to tailor administration of these agents
    • Provided Health Canada with evidence on the safety of these agents for their decision-making
    • Featured in a media article targeting epileptic patients and physicians
    Funding:

    Canadian Institutes of Health Research (CIHR)/ Drug Safety and Effectiveness Network (DSEN)

     

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    Date : 25 Aug 2017