masterThesis
Corticosteroides vs dosis bajas de adrenocorticotropina en el tratamiento de espasmos infantiles. Revisión sistemática de la literatura
Fecha
2013Autor
Rodríguez Calderón, Yazmín Astrid
Institución
Resumen
Background: The treatment of infantile spasms usually performed
with ACTH despite side effect profile and the high financial cost. It has
been proposed the use of corticosteroids as first-line treatment for the
disease, although there is uncertainty about the effectiveness of this
scheme.
Objectives: To evaluate the efficacy of corticosteroids compared with
ACTH as first-line treatment in the management of patients with
infantile spasms.
Methodology: We conducted a systematic review of the literature. The
search was conducted in the databases Pubmed, Embase, Ovid,
LILACS and the registration of clinical trials in the United States. We
included studies in Portuguese, English and Spanish, no fixed time limit
for publication. An analysis of risk of bias and quality of evidence
using the program GRADEPRO. OR were estimated and their
confidence intervals at 95%.
Results: We included four studies, clinical trials and three retrospective
cohort studies. Two studies provided evidence of moderate and high
quality. No differences were found in the short-term efficacy between
the use of corticosteroids and ACTH on clinical outcomes or EEG. No
studies of long-term safety. The short-term safety showed no
difference.
Conclusions: It is likely that the use of corticosteroids as first-line
treatment can replace the use of ACTH, safety studies required long
term. The routine use decision should be based on an analysis of costeffectiveness
and under the gaze of the risk / benefit balance.