Prednisolone/prednisone as adrenocorticotropic hormone alternative for infantile spasms: a meta‐analysis of randomized controlled trials

Abstract

Aim To compare the efficacy and safety of prednisolone/prednisone and adrenocorticotropic hormone (ACTH) in the treatment of infantile spasms using a meta‐analysis of randomized controlled trials (RCTs). Method In a systematic literature search of electronic databases (MEDLINE, Embase, the Cochrane Library), we identified RCTs that assessed prednisolone/prednisone compared with ACTH/tetracosactide in patients with infantile spasms. The electroclinical response and adverse events were evaluated. Results Six RCTs (616 participants) were included in the meta‐analysis. Compared with prednisolone/prednisone, ACTH/tetracosactide was not superior in terms of cessation of spasms at day 14 (relative risk 1.19, 95% confidence interval [CI] 0.74–1.92), day 42 (relative risk 1.02, 95% CI 0.63–1.65), and resolution of hypsarrhythmia on electroencephalogram (relative risk 1.14, 95% CI 0.71–1.81); the incidences of common adverse reactions caused by ACTH/tetracosactide were not lower than that of prednisolone/prednisone for irritability (relative risk 0.79, 95% CI 0.57–1.10), increased appetite (relative risk 0.78, 95% CI 0.57–1.08), weight gain (relative risk 0.86, 95% CI 0.56–1.32), and gastrointestinal upset (relative risk 0.60, 95% CI 0.35–1.02), though it seemed less frequent. Interpretation Prednisolone/prednisone elicits a similar electroclinical response as ACTH for infantile spasms, which indicates that it can be an alternative to ACTH for treating infantile spasms. What this paper adds Prednisolone/prednisone is as effective as adrenocorticotropic hormone (ACTH) in electroclinical response of infantile spasms. Prednisolone/prednisone and ACTH cause similar and tolerable adverse effects, whose incidences are comparable. High‐dose prednisone/prednisolone might be preferable to low dose for achieving freedom from spasms.

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.…”

A Unique Case of Pyruvate Carboxylase Deficiency

“…Aspartic acid lowers ammonia levels, letting the urea cycle take place [ 12 ]. Lorazepam and clobazam are used to treat seizures in patients with PCD, and prednisone controls infantile spasms [ 13 ]. The treatment that our patient received was: thiamine, aspartic acid, biotin, citric acid-sodium citrate, clobazam, and levocarnitine, which is appropriate according to the literature [ 12 ].…”

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.…”