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For the initial management of
infantile spasms, ACTH and oral steroids are superior in comparison with
non-standard therapy.
A study published in Neurology offered Class III evidence that for children with newly onset infantile spasms, adrenocorticotropic hormone (ACTH) or oral steroids have superior efficacy when compared to non-standard therapies. Researchers aimed to investigate the efficacy of initial therapy for infantile spasms that initiated at age 2-24 months in children.
Children with novel onset infantile spasms were prospectively followed by the National Infantile Spasms Consortium. Freedom from therapy failure at sixty days needed no 2nd therapy for infantile spasms and no clinical spasms following thirty days of therapy initiation. With the aid of within-center correlation with generalized estimating equations and propensity score weighting, management of therapeutic selection bias was done. The freedom from treatment failure rates is shown in Table 1:
The alteration from oral steroids to ACTH was not estimated to impact response (noted 44% estimated to alter to 44%). The alteration from the non-standard treatment to ACTH would enhance response from 8% to 39%, and to oral steroids from 8% to 38%. Notably, large but not profound estimated effects of altering from vigabatrin to ACTH (29% to 42%), vigabatrin to oral steroids (29% to 42%), and non-standard treatment to vigabatrin (8% to 20%) were witnessed.
Considering children managed with
vigabatrin, children suffering from tuberous sclerosis complex responded more
frequently when compared to others (62% vs 29%). The estimated efficacy of
vigabatrin is between non-standard treatment and ACTH / oral steroids, despite
the fact that the study sample was underpowered for statistical confidence.
When utilized, vigabatrin worked best for the tuberous sclerosis complex.
Neurology
Comparative Effectiveness of Initial Treatment for Infantile Spasms in a Contemporary US Cohort
Zachary M. Grinspan et al.
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