Effectiveness of corticosteroids versus adrenocorticotropic hormone for infantile spasms: a systematic review and meta‐analysis

Abstract

ObjectiveTo compare the therapeutic effectiveness of oral corticosteroids with that of adrenocorticotrophic hormone for infantile spasms.MethodsPubMed, Embase, Scopus, and the Cochrane library were searched to retrieve studies published before December 2018 to identify pediatric patients with a diagnosis of infantile spasms. The interventions of oral corticosteroids and adrenocorticotrophic hormone were compared. We included only randomized controlled trials that reported the cessation of spasms as treatment response. The primary outcome was clinical spasm cessation on day 13 or 14. The secondary outcomes were the resolution of hypsarrhythmia, side effects, continued spasm control, spasm relapse rate, and subsequent epilepsy rate. Following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses, the study‐level quality assessment was conducted using the Cochrane risk‐of‐bias tool.ResultsAfter extensive review, 39 articles were included for meticulous evaluation. Five randomized controlled trials with a total of 239 individuals were eligible for further analysis. No significant difference was detected between the corticosteroids and adrenocorticotrophic hormone in the cessation of clinical spasms (odds ratio [OR]: 0.54; 95% confidence interval [CI]: 0.16 to 1.81; P = 0.32). The subgroups of high‐dose prednisolone versus adrenocorticotrophic hormone and low‐dose prednisone versus adrenocorticotrophic hormone also exhibited no significant difference. Furthermore, the two subgroups did not differ in terms of hypsarrhythmia resolution, side effects, relapse rate, or subsequent epilepsy rate.InterpretationThis meta‐analysis suggests that high‐dose prednisolone is not inferior to adrenocorticotrophic hormone and that it be considered a safe and effective alternative treatment.

Cost‐effectiveness of adrenocorticotropic hormone versus oral steroids for infantile spasms

“…37,38 These meta-analyses considered only RCTs. 37,38 Although RCTs are the most rigorous methodology, they can have limitations. 39 For instance, there can be inherent challenges while enrolling patients, as shown by the data from the UKISS trial, where among the eligible F I G U R E 3 Comparison of cost-effectiveness of adrenocorticotropic hormone (ACTH) and prednisolone for infantile spasms.…”

“…Recent systematic reviews and meta‐analyses of RCTs have failed to demonstrate superiority of ACTH over oral steroids for infantile spasms 37,38 . These meta‐analyses considered only RCTs 37,38 . Although RCTs are the most rigorous methodology, they can have limitations 39 .…”

COVID-19: A Review for the Pediatric Neurologist

“…Hormone therapy with ACTH, or increasingly, high-dose steroids, is considered the first-line treatment for infantile spasms not associated with tuberous sclerosis. [53][54][55] However, ACTH can profoundly suppress the immune response in infection. 56,57 If patients with infantile spasms have comorbidities, or will be admitted to the hospital for monitoring, increasing their risk of contracting COVID-19, it may be reasonable to consider vigabatrin or steroids instead of ACTH.…”

Improving Management of Infantile Spasms by Adopting Implementation Science

“…17 Chang et al published a systematic review/meta-analysis using five RCTs with a total of 239 individuals and detected no difference between corticosteroids and ACTH in the cessation of clinical spasms, hypsarrhythmia resolution, side effects, relapse rate, or rate of development of epilepsy subsequently. 18…”