Lamotrigine (All indications)

Neuro-developmental disorders (as a whole)

R analysis
id Study   Lib. in paper Exposition period    Study type  Control type 
 
Tags OR 95%CI x1/n1 x0/n0 no cases no exposed ROB Ref.
S12727
R48004
Bjørk (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2022 Neurodevelopmental Disorder (ND): any diagnoses of autism spectrum disorder (F84.0, F84.1, F84.5) or intellectual disability (F70, F71, F72, F73) plus F84.3, F84.4, F84.8, F84.9, F79 (between 6.1 and 7.9 years old) during pregnancy (anytime or not specified) population based cohort retrospective unexposed (general population or NOS) excluded Adjustment: Yes 1.27 [1.07;1.50]
excluded (control group)
133/7,950   68,295/4,463,879 68,428 7,950
ref
S12728
R48007
Bjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022 Neurodevelopmental Disorder (ND): any diagnoses of autism spectrum disorder (F84.0, F84.1, F84.5) or intellectual disability (F70, F71, F72, F73) plus F84.3, F84.4, F84.8, F84.9, F79 (between 6.1 and 7.9 years old) during pregnancy (anytime or not specified) population based cohort retrospective unexposed, sick Adjustment: No Controls: epilepsy indication 0.81 [0.67;0.99] C 133/7,950   443/21,634 576 7,950
ref
S8978
R30439
Coste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020 Diagnosis Disorders of psychological development (F80–F89) (mean age of 3.6 years old) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes 1.50 [1.00;2.10] 27/2,813   9,949/1,707,707 9,976 2,813
ref
S8937
R30212
Charlton (Lamotrigine) (Controls unexposed, disease free), 2017 Neurodevelopmental disorders (at 6 years old) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, disease free excluded Adjustment: No Matched 0.42 [0.03;6.86] C
excluded (control group)
0/122   58/6,048 58 122
ref
S8938
R30213
Charlton (Lamotrigine) (Controls unexposed, sick), 2017 Neurodevelopmental disorders (at 6 years old) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, sick Adjustment: No 0.20 [0.01;3.47] C 0/122   9/472 9 122
ref
S8933
R30193
Bromley (Lamotrigine) (Controls unexposed, disease free), 2013 Neurodevelopmental disorder (at 6 years old) during pregnancy (anytime or not specified) prospective cohort unexposed, disease free excluded Adjustment: Yes 4.06 [0.55;22.20]
excluded (control group)
2/30   4/214 6 30
ref
S8936
R30209
Bromley (Lamotrigine) (Controls unexposed, sick), 2013 Neurodevelopmental disorder (at 6 years old) during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No 4.64 [0.21;101.27] C 2/30   0/26 2 30
ref
S8952
R30277
Rihtman (Lamotrigine), 2013 Children: special education (Preschool children: mean age 4-5y) at least 1st trimester prospective cohort unexposed (general population or NOS) Adjustment: No 1.24 [0.08;20.50] C 1/42   1/52 2 42
ref
S8919
R30142
Dean (Lamotrigine), 2007 Neurodevelopmental disorder (mean age in years: m1=1.5 and m0=15.25) during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No 1.73 [0.07;40.78] C 0/4   3/46 3 4
ref
Total 6 studies 1.08 [0.66;1.76] 10,568 10,961
x1: number of endpoints among exposed, n1: number of exposed; x0: number of endpoints among non exposed, n0: number of non exposed; C: calculated odds ratio from numbers of events and effectives

Forest plot

StudyTE95% CIn casesn exposedweightROBABCDEF Bjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022Bjørk, 2022 1 0.81[0.67; 0.99]5767,95049%ROB confusion: unclearROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Coste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020Coste, 2020 2 1.50[1.00; 2.10]9,9762,81341%ROB confusion: seriousROB selection: moderateROB classification: moderateROB missing: moderateROB mesure: criticalROB reporting: moderate Charlton (Lamotrigine) (Controls unexposed, sick), 2017Charlton, 2017 3 0.20[0.01; 3.47]91223%ROB confusion: unclearROB selection: lowROB classification: criticalROB missing: lowROB mesure: criticalROB reporting: moderate Bromley (Lamotrigine) (Controls unexposed, sick), 2013Bromley, 2013 4 4.64[0.21; 101.27]2302%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: moderateROB mesure: moderateROB reporting: moderate Rihtman (Lamotrigine), 2013Rihtman, 2013 5 1.24[0.08; 20.50]2423%ROB confusion: moderateROB selection: moderateROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Dean (Lamotrigine), 2007Dean, 2007 6 1.73[0.07; 40.78]342%ROB confusion: criticalROB selection: criticalROB classification: lowROB missing: criticalROB mesure: criticalROB reporting: moderate Total (6 studies) I2 = 52% 1.08[0.66; 1.76]10,56810,9610.210.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Lamotrigine) (Controls unexposed, sick) (Mixed indications; 2: Lamotrigine) (Controls unexposed NOS) (Mixed indications; 3: Lamotrigine) (Controls unexposed, sick; 4: Lamotrigine) (Controls unexposed, sick; 5: Lamotrigine; 6: Lamotrigine;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.08[0.66; 1.76]10,56810,96152%NABjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022 Coste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020 Charlton (Lamotrigine) (Controls unexposed, sick), 2017 Bromley (Lamotrigine) (Controls unexposed, sick), 2013 Rihtman (Lamotrigine), 2013 Dean (Lamotrigine), 2007 6 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.50[1.04; 2.16]9,9782,8550%NACoste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020 Rihtman (Lamotrigine), 2013 2 unexposed, sickunexposed, sick 0.82[0.67; 0.99]5908,1060%NABjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022 Charlton (Lamotrigine) (Controls unexposed, sick), 2017 Bromley (Lamotrigine) (Controls unexposed, sick), 2013 Dean (Lamotrigine), 2007 4 Tags Adjustment   - No  - No 0.82[0.67; 0.99]5928,1480%NABjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022 Charlton (Lamotrigine) (Controls unexposed, sick), 2017 Bromley (Lamotrigine) (Controls unexposed, sick), 2013 Rihtman (Lamotrigine), 2013 Dean (Lamotrigine), 2007 5   - Yes  - Yes 1.50[1.04; 2.17]9,9762,813 -NACoste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020 1 Controls   - epilepsy indication  - epilepsy indication 0.81[0.67; 0.99]5767,950 -NABjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022 1 All studiesAll studies 1.08[0.66; 1.76]10,56810,96152%NABjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022 Coste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020 Charlton (Lamotrigine) (Controls unexposed, sick), 2017 Bromley (Lamotrigine) (Controls unexposed, sick), 2013 Rihtman (Lamotrigine), 2013 Dean (Lamotrigine), 2007 60.110.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.83.91.9330.000Bjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022Coste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020Charlton (Lamotrigine) (Controls unexposed, sick), 2017Bromley (Lamotrigine) (Controls unexposed, sick), 2013Rihtman (Lamotrigine), 2013Dean (Lamotrigine), 2007

Asymetry test p-value = 0.5896 (by Egger's regression)

slope=-0.1376 (0.1780); intercept=0.4854 (0.8288); t=0.5856; p=0.5896

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 8933, 8937, 12727

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.31[1.13; 1.53]78,47010,9570%NABjørk (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2022 Coste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020 Charlton (Lamotrigine) (Controls unexposed, disease free), 2017 Bromley (Lamotrigine) (Controls unexposed, disease free), 2013 Rihtman (Lamotrigine), 2013 5 unexposed, sick controlsunexposed, sick controls 0.82[0.67; 0.99]5908,1060%NABjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022 Charlton (Lamotrigine) (Controls unexposed, sick), 2017 Bromley (Lamotrigine) (Controls unexposed, sick), 2013 Dean (Lamotrigine), 2007 40.510.01.0