Effects of Antiseizure Medications on Lipid Profile: A Systematic Review with Meta-Analysis
Paweł Chochoł1, Natalia Arturo Restrepo2, Aisha Rizwan Ahmed3, Aishwarya Koppanatham4, Thomas C. Varkey5
1University of Warmia and Mazury, 2Universidad CES, 3Jinnah Medical And Dental College, 4Andhra Medical College, 5University of Arizona School of Medicine Phoenix
Objective:
This meta-analysis evaluated the effects of antiseizure medications (ASM) on lipid profile and weight changes contributing to the overall metabolic and cardiovascular risk in patients with epilepsy. This paper aims to give a detailed insight into safety profiles across different patient subgroups and the impact of the duration of treatment which was previously underrepresented in individual studies that show conflicting results.
Background:
Hyperlipidemia is recognized as a prominent risk factor of atherosclerosis. An abnormal metabolic profile has been described in many patients with epilepsy on ASM therapy, with total cholesterol (TC) and low-density lipoprotein (LDL) playing an important role. Nevertheless, a proper correlation has not been established.
Design/Methods:
PubMed, Embase and Cochrane Central databases were searched for studies reporting lipid derangements after at least three months of ASM monotherapy. Twenty nine studies totalling over 3500 patients were included. Mean difference and standardized mean difference were computed using random-effects model. Further subgroup analyses based on adult and pediatric population and duration of treatment, also sensitivity analyses were performed where feasible.
Results:
Comprehensive assessment of TC and LDL levels is warranted for patients receiving carbamazepine throughout, as well as children undergoing treatment with oxcarbazepine early after its initiation and adults on long-term phenytoin and valproate. The effect size of the first two ASMs is the largest one among the others. Levetiracetam seems to be neutral. Weight gain is observed during treatment, particularly in adult population concerning carbamazepine from the beginning of therapy, valproate during the long-term, lamotrigine or levetiracetam as well, and oxcarbazepine in the pediatric cohort.
Conclusions:
This systemic review and meta-analysis suggest that ordering blood tests for the lipids in epileptic patients during therapy with different antiseizure medications early in the course of treatment should be, together with the weight changes, an important part of the evaluation of the metabolic risk of these agents.
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