META-ANALYSIS

4CLPH - Group 9
Canlas Gatus Mallillin Panaligan Vergara
DEPARTMENT OF PHARMACY Faculty of Pharmacy University of Santo Tomas Espaa, Manila

META-ANALYSIS

DEPARTMENT OF PHARMACY Faculty of Pharmacy University of Santo Tomas Espaa, Manila

ARTICLE TITLE AND CITATION

Professional Reputation: Department of Surgery Aga Khan University Karachi, Pakistan

Peer-review: Published last May 29, 2012

ARTICLE TITLE AND CITATION

Investigators: Abdul Ahad Khan Asfar Ayaz Ghauri Syed Nabeel Zafar Muhammad Shahzad Shamim Location: Karachi, Pakistan

BACKGROUND OF THE STUDY

Current standard therapy for seizure prophylaxis in Neuro-surgical patients involves the use of Phenytoin (PHY). However, a new drug Levetiracetam (LEV) is emerging as an alternate treatment choice. We aimed to conduct a metaanalysis to compare these two drugs in patients with brain injury.

OBJECTIVES
1. To compare Phenytoin (PHY) and Levetiracetam (LEV) as a therapy for seizure prophylaxis in patients with brain injury 2. To conduct a meta-analysis of studies comparing the efficacy of these two drugs in patients with brain injury.

FUNDING SOURCES
This study did not receive any funding. None of the authors received funding in part or in full for contribution to this study or for any related work.

METHODS
Study Design
- Electronic research

- Filters for:
PHY (Phenytoin, Dilantin) LEV (Levetiracetam, Kepra) Brain injury

METHODS
Intervention The study utilized the Newcastle-Ottawa Scale to asses the quality of studies selected for the analysis. Study Population The study population consisted of patients with brain injury.

METHODS
Inclusion Criteria Comparative study Study comparing LEV to PHY Exclusion Criteria Studies which utilized combination therapies instead of LEV and PHY monotherapy

METHODS
Data abstraction We extracted data from all eligible studies on to a standardized data abstraction sheet. The extraction was checked by another author independent of the first. We extracted information on study characteristics, characteristics of the population under study, operational definitions and outcomes...

METHODS
Positive Attributes The study was performed to compare the efficacy of current standard therapy for seizure prophylaxis in Neuro-surgical patients which involves the use of Phenytoin (PHY) and a new drug Levetiracetam (LEV) which is now emerging as an alternate treatment choice. Meta-analysis was conducted to compare these two drugs in patients with brain injury.

METHODS
Positive Attributes The study was performed to compare the efficacy of current standard therapy for seizure prophylaxis in Neuro-surgical patients which involves the use of Phenytoin (PHY) and a new drug Levetiracetam (LEV) which is now emerging as an alternate treatment choice. Meta-analysis was conducted to compare these two drugs in patients with brain injury.

RESULTS
Primary Result The pooled estimates Odds Ratio 1.12 (95% CI = 0.34, 3.64) demonstrated no superiority of either drug at preventing the occurrence of early seizures.

RESULTS
Secondary Result In a subset analysis of studies in which follow up for seizures lasted either 3 or 7 days, the effect estimate remained insignificant with an odds ratio of 0.96 (95% CI = 0.34, 2.76). Similarly, 2 trials reporting seizure incidence at 6 months also had insignificant pooled results while comparing drug efficacy. The pooled odds ratio was 0.96 (95% CI = 0.24, 3.79).

RESULTS
Miscellaneous Results The literature search identified 2489 unduplicated papers. Of these 2456 papers were excluded by reading the abstracts and titles. Another 25 papers were excluded after reading their complete text. Eight papers were selected which comprised of 2 RCTs and 6 observational studies.

RESULTS
Acknowledged Limitations A limitation of this study is that it did not account for the costs related to monitoring of phenytoin blood levels or for the cost of side effects. Also, the study assumed that severe adverse events that could impact costs were rare for each drug.

RESULTS
Baseline

KEY POINTS
There is no significant difference in the effectiveness of Phenytoin and Leviteracetam in early or late seizure prophylaxis. The authors concluded that Leviteracetam can only be more cost effective than phenytoin if it prevented 100% of seizures and costed less than $400 for a 7 day course.

KEY POINTS

CONCLUSION
There is no significant difference on seizure prophylaxis for either early or late seizures for either Phenytoin or Levetiracetam. Still, more quality literatures from different parts of the world are highly suggested to provide a more accurate and precise conclusions.

SYSTEMATIC REVIEW
4CLPH - Group 9
Canlas Gatus Mallillin Panaligan Vergara
DEPARTMENT OF PHARMACY Faculty of Pharmacy University of Santo Tomas Espaa, Manila

SYSTEMATIC REVIEW

DEPARTMENT OF PHARMACY Faculty of Pharmacy University of Santo Tomas Espaa, Manila

ARTICLE TITLE AND CITATION

The Clinical Effect of topical Phenytoin on Wound Healing: A Systematic Review

E-Publication: September 13, 2007 (PubMed)

ARTICLE TITLE AND CITATION

Investigators: Shaw J Hughes CM Lagan KM Bell PM Location: United Kingdom

BACKGROUND OF THE STUDY

Oral phenytoin was first introduced as an antiseizure medication in 1937. Over 60 years investigators have shown an interest in how topical phenytoin may be used to promote wound healing in a variety of chronic wounds.

OBJECTIVES
1. To systematically to identify, summarize and critically appraise the clinical evidence available on the effects of topical phenytoin on wound healing

FUNDING SOURCES
No sponsorship funding

METHODS
Positive Attributes The primary objectives of the study was to systematically identify, summarize and critically appraise the clinical evidence available on the effects of topical phenytoin on wound healing.

RESULTS
Primary Result There was moderate evidence presented to support the use of phenytoin for the treatment of leg ulcers, leprosy wounds, chronic wounds and diabetic foot ulcers.
There was limited evidence for the use of phenytoin on burns and war wounds.

RESULTS
Primary Result There was a positive percentage treatment effect in favor of the phenytoin-treated group in one study investigating diabetic foot wounds and one study on chronic wounds.

RESULTS
Miscellaneous Results Fourteen RCTs were included in the systematic review. Two papers were of high and 12 papers of low to moderate methodological quality.

KEY POINTS
The systematic review focused on summarizing information regarding the effects of topical phenytoin in wound healing through critical analysis of studies made by other researchers. Most papers that were used in the study did not provide a well-defined methodology and did not provide much evidence on the use of phenytoin on certain wounds.

KEY POINTS
Diabetic wounds and chronic wounds respond positively to topical phenytoin according to this systematic review thus healthcare provider may consider topical phenytoin as a possible treatment for this wounds.

KEY POINTS
The results shows that the wound healing effect of topical phenytoin differs on variety of wounds.

CONCLUSION
Overall it would appear that studies investigating the effect of topical phenytoin on wound healing are of moderate methodological quality, and these suggest that there may be a positive effect on wound healing in a variety of wounds.