Objective:
Status epilepticus is a major emergency condition. The choice of
antiepileptic drugs for second-line treatment after
benzodiazepine remains controversial, including
levetiracetam vs.
fosphenytoin. We compare the safety of intravenous
levetiracetam and
fosphenytoin as a second-line treatment in patients with
status epilepticus using a nationwide database. Methods: An observational study conducted with the Japanese Diagnosis Procedure Combination inpatient database identified adult patients who had been admitted for
status epilepticus and who had received intravenous
diazepam on the day of admission from March 1, 2011 to March 31, 2018. Patients who received intravenous
levetiracetam on the day of admission were defined as the
levetiracetam group and those who received intravenous
fosphenytoin on the day of admission were defined as the
fosphenytoin group. Propensity score matching was performed to compare outcomes obtained for the
levetiracetam and
fosphenytoin groups. Results: The analysis examined data of 5,667 patients. Overall, 1,403 (25%) patients received
levetiracetam; 4,264 (75%) received
fosphenytoin. One-to-one propensity score matching created 1,363 matched pairs. No significant difference was found in in-hospital mortality (5.2 vs. 5.1%; odds ratio, 1.03; 95% confidence interval, 0.73-1.46). The proportion of vasopressor use on the day of admission was significantly lower for the
levetiracetam group than for the
fosphenytoin group (3.2 vs. 4.9%; odds ratio, 0.63; 95% confidence interval, 0.43-0.92). No significant difference was found in other secondary outcomes including total hospitalization cost. Conclusion:
Levetiracetam was related to significantly reduced vasopressor use on the day of admission than that found for
fosphenytoin, in adult
status epilepticus.