Levetiracetam noninferior to, safer than phenobarbital

As a first-line antiseizure medication (ASM) for infants, levetiracetam (LEV) is potentially noninferior to phenobarbital (PB) and shows a more acceptable safety profile, a new study has found.

Researchers conducted a retrospective cohort analysis of 108 newborns who had had their seizures confirmed through electroencephalography (EEG). Thirty-one percent (n=33) were treated with first-line LEV, while the remaining 69 percent (n=75) received PB. Treatment response was defined as complete cessation of EEG seizures and needing no further ASM for symptom control.

Only 39 percent of all infants achieved freedom from seizures after first-line therapy. Treatment response did not differ between the LEV and PB arms (p=0.40). Conducting analyses according to seizure aetiology likewise revealed no significant difference in response rates in those with symptomatic seizures (p=0.59) and hypoxic-ischaemic encephalopathy (p=0.71).

Similarly, treatment response was comparable between LEV and PB regardless of seizure frequency or treatment dose.

In terms of safety, researchers reported a 24-percent (n=22) prevalence rate of adverse events in infants treated with PB. Meanwhile, only 1 percent (n=1) of LV comparators developed such side effects.

“PB was associated with more adverse events than LEV, and the two ASMs were equally but incompletely effective in treating neonatal seizures. Our findings suggest that LEV may be a safe and effective alternative to PB as a first-line therapy in these neonates,” the researchers said.

“In future studies, further subgroup analyses of treatment response may shed some light on the efficacy of LEV vs PB in specific settings. Long-term follow-up analyses in infants previously treated with LEV vs PB for neonatal seizures are crucial to address the impact of these ASMs on long-term seizure and cognitive outcomes,” they added.