The Journal of pediatrics · 2025
Leukopenia in Children on Antiseizure Medication is Common and Has Minor Clinical Impact.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Pettersson Hanna, Alani Tamara, Rydén Ingehla, Stödberg Tommy, Eksborg Staffan, Sundin Mikael
Аннотация
OBJECTIVE: To explore the prevalence, risk factors, and impact of leukopenia among children treated with antiseizure medication (ASM) in a real-world setting.
STUDY DESIGN: The most recent 198 pediatric (<18 years) patients treated with ASMs at Astrid Lindgren Children's Hospital were included in a retrospective cohort study. Clinical variables were collected from electronic medical records. Patients who did and did not develop leukopenia were compared.
RESULTS: Ninety-seven (49%) patients developed at least 1 episode of leukopenia. Most episodes (180 [88%]) were mild (ie, lower normal limit - 3.0 × 109 cells/L) and no patient developed life-threatening leukopenia or died. Clinical actions (ie, ASM switch or tapering) were taken in only 9 (4%) episodes of leukopenia. The clinical impact was leukopenia symptoms in 7 (3%) episodes, and other blood cell cytopenias more frequently (62% vs 18%; P < .001) compared with children without leukopenia. The risk factors for developing leukopenia were dysfunction in other organ systems (eg, endocrinologic disorders, heart disease, or kidney disease), longer treatment duration, ASM combination treatments, and slightly older age (mean 11 vs 9 years, P = .03). Leukopenia was seen in treatments with almost all ASMs (ie, substances) with only a few significant differences between the groups. There was no difference in leukopenia incidence between older vs newer ASMs.
CONCLUSIONS: Leukopenia is a far more common side-effect of ASMs than earlier described. However, this leukopenia is mostly asymptomatic and without complications. If mild leukopenia occurs, ASM discontinuation or adjustment may not be necessary.
STUDY DESIGN: The most recent 198 pediatric (<18 years) patients treated with ASMs at Astrid Lindgren Children's Hospital were included in a retrospective cohort study. Clinical variables were collected from electronic medical records. Patients who did and did not develop leukopenia were compared.
RESULTS: Ninety-seven (49%) patients developed at least 1 episode of leukopenia. Most episodes (180 [88%]) were mild (ie, lower normal limit - 3.0 × 109 cells/L) and no patient developed life-threatening leukopenia or died. Clinical actions (ie, ASM switch or tapering) were taken in only 9 (4%) episodes of leukopenia. The clinical impact was leukopenia symptoms in 7 (3%) episodes, and other blood cell cytopenias more frequently (62% vs 18%; P < .001) compared with children without leukopenia. The risk factors for developing leukopenia were dysfunction in other organ systems (eg, endocrinologic disorders, heart disease, or kidney disease), longer treatment duration, ASM combination treatments, and slightly older age (mean 11 vs 9 years, P = .03). Leukopenia was seen in treatments with almost all ASMs (ie, substances) with only a few significant differences between the groups. There was no difference in leukopenia incidence between older vs newer ASMs.
CONCLUSIONS: Leukopenia is a far more common side-effect of ASMs than earlier described. However, this leukopenia is mostly asymptomatic and without complications. If mild leukopenia occurs, ASM discontinuation or adjustment may not be necessary.