Safety and efficacy of lithium in patients with amyotrophic lateral sclerosis: a systematic review and meta-analysis of randomized controlled trials.

Abstract

OBJECTIVES:

This study provides a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating the safety and efficacy of lithium in amyotrophic lateral sclerosis (ALS) patients.

METHODS:

PubMed, Web of Science, Cochrane CENTRAL, Scopus, and Your Journals@Ovid were searched up to 9 December 2022. RCTs investigating lithium, either alone or with any supplement, in ALS patients were included. Meta-analysis was performed using RevMan and results are presented in forest plot.

RESULTS:

Four RCTs with 469 patients met the inclusion criteria and were included in our study. Lithium doses varied among the included studies and one study used a combined therapy of lithium with valproate. Meta-analysis showed no difference between lithium and placebo regarding severe adverse events (odds ratio = 1.13, 95% confidence interval: 0.73 to 1.75, P = 0.58). No significant differences were observed with regard to survival rate between the two groups (hazard ratio = 0.95, 95% confidence interval: 0.65 to 1.37, P = 0.77). There were also no significant differences between the two groups with regard to average changes of revised amyotrophic lateral sclerosis functional rating scale (P = 0.35) and forced vital capacity percentage predicted (P = 0.73). Subgroup analysis showed no significant differences regarding all investigated outcomes either for lithium alone or lithium with valproate.

CONCLUSION:

Current evidence suggests a safety profile with no benefit of lithium for ALS. However, given the limited number of RCTs and the safety findings, we recommend further well-designed RCTs to investigate lithium and valproate in ALS patients.

• Authors: Abdullah Ashraf Hamad, Amir N Attia, Nada Mostafa Al-Dardery, Shrouk F Mohamed, Mostafa Meshref
• Journal: Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology (Neurol Sci) Vol. 44 Issue 9 Pg. 3029-3036 (Sep 2023) ISSN: 1590-3478 [Electronic] Italy
• PMID: 37069469 (Publication Type: Meta-Analysis, Systematic Review, Journal Article, Review)
• Copyright: © 2023. Fondazione Società Italiana di Neurologia.

Chemical References

• Lithium
• Valproic Acid

Topics

• Humans
• Amyotrophic Lateral Sclerosis (therapy)
• Lithium (adverse effects)
• Valproic Acid (adverse effects)
• Randomized Controlled Trials as Topic
• Vital Capacity