Carbamazepine (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.
S12749
R48105
Bjørk (Carbamazepine) (Controls exposed to Lamotrigine, 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 exposed to other treatment, sick excluded Adjustment: No 1.84 [1.42;2.40] C
excluded (control group)
99/3,256   133/7,950 232 3,256
ref
S12748
R48102
Bjørk (Carbamazepine) (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 1.59 [1.30;1.93]
excluded (control group)
99/3,256   68,295/4,463,879 68,394 3,256
ref
S12747
R48099
Bjørk (Carbamazepine) (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 1.50 [1.20;1.87] C 99/3,256   443/21,634 542 3,256
ref
S9777
R34983
Coste (Carbamazepine) (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 2.00 [1.00;4.10] 8/468   9,949/1,707,707 9,957 468
ref
S9703
R34542
Charlton (Carbamazepine) (Controls exposed to Lamotrigine, sick), 2017 Neurodevelopmental disorders (at 6 years old) during pregnancy (anytime or not specified) retrospective cohort (claims database) exposed to other treatment, sick excluded Adjustment: No 9.38 [0.51;171.34] C
excluded (control group)
5/148   0/122 5 148
ref
S9704
R34543
Charlton (Carbamazepine) (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: Yes Matched 2.75 [0.92;8.24]
excluded (control group)
5/148   58/6,048 63 148
ref
S9705
R34544
Charlton (Carbamazepine) (Controls unexposed, sick), 2017 Neurodevelopmental disorders (at 6 years old) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, sick Adjustment: No 1.80 [0.59;5.45] C 5/148   9/472 14 148
ref
S9597
R33989
Arkilo (Carbamazepine), 2015 Abnormal development (At 2 years of age, assessed by developmental specialists) during pregnancy (anytime or not specified) retrospective cohort exposed to other treatment, sick Adjustment: No 2.73 [0.39;18.88] C 3/14   2/22 5 14
ref
S9696
R34507
Bromley (Carbamazepine) (Controls exposed to Lamotrigine, sick), 2013 Neurodevelopmental disorder (at 6 years old) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick excluded Adjustment: No 0.29 [0.02;3.29] C
excluded (control group)
1/50   2/30 3 50
ref
S9699
R34523
Bromley (Carbamazepine) (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 1.09 [0.06;7.39]
excluded (control group)
1/50   4/214 5 50
ref
S9702
R34539
Bromley (Carbamazepine) (Controls unexposed, sick), 2013 Neurodevelopmental disorder (at 6 years old) during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No 1.58 [0.06;40.13] C 1/50   0/26 1 50
ref
S9660
R34392
Dean (Carbamazepine) (Controls exposed to Lamotrigine, sick), 2007 Neurodevelopmental disorder (mean age in years: m1=5.08 and m0=1.5) during pregnancy (anytime or not specified) retrospective cohort exposed to other treatment, sick excluded Adjustment: No 2.06 [0.10;41.80] C
excluded (control group)
17/77   0/4 17 77
ref
S9661
R34394
Dean (Carbamazepine) (Controls unexposed, sick), 2007 Neurodevelopmental disorder (mean age in years: m1=5.08 and m0=15.25) during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No 4.06 [1.12;14.73] C 17/77   3/46 20 77
ref
S9747
R34801
Viinikainen (Carbamazepine) b, 2006 Need for educational support throughout pregnancy prospective cohort unexposed, sick Adjustment: No 1.00 [0.12;8.42] C 2/13   2/13 4 13
ref
S9593
R33971
Adab (Carbamazepine), 2004 Any additional educational needs during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No 0.63 [0.30;1.33] 14/61   28/87 42 61
ref
S9627
R34239
Katz (Carbamazepine), 2001 Developmental delay (Based on the DSM-IV-TR criteria) during pregnancy (anytime or not specified) retrospective cohort exposed to other treatment, sick Adjustment: No 1.36 [0.06;33.80] C 4/21   0/3 4 21
ref
S9740
R34704
Van der Pol (Carbamazepine) (Controls unexposed, disease free), 1991 Nonoptimal school career throughout pregnancy prospective cohort unexposed, disease free excluded Adjustment: No Matched 0.22 [0.01;4.05] C
excluded (control group)
0/10   10/54 10 10
ref
S9741
R34729
Van der Pol (Carbamazepine) (Controls unexposed, sick), 1991 Nonoptimal school career throughout pregnancy prospective cohort unexposed, sick Adjustment: No 0.16 [0.01;3.18] C 0/10   5/22 5 10
ref
Total 10 studies 1.46 [1.05;2.03] 10,594 4,118
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 (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022Bjørk, 2022 1 1.50[1.20; 1.87]5423,25647%ROB confusion: unclearROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Coste (Carbamazepine) (Controls unexposed, NOS) (Mixed indications), 2020Coste, 2020 2 2.00[1.00; 4.10]9,95746816%ROB confusion: seriousROB selection: moderateROB classification: moderateROB missing: moderateROB mesure: criticalROB reporting: moderate Charlton (Carbamazepine) (Controls unexposed, sick), 2017Charlton, 2017 3 1.80[0.59; 5.45]141488%ROB confusion: unclearROB selection: lowROB classification: criticalROB missing: lowROB mesure: criticalROB reporting: moderate Arkilo (Carbamazepine), 2015Arkilo, 2015 4 2.73[0.39; 18.88]5143%ROB confusion: criticalROB selection: criticalROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Bromley (Carbamazepine) (Controls unexposed, sick), 2013Bromley, 2013 5 1.58[0.06; 40.13]1501%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: moderateROB mesure: moderateROB reporting: moderate Dean (Carbamazepine) (Controls unexposed, sick), 2007Dean, 2007 6 4.06[1.12; 14.73]20776%ROB confusion: criticalROB selection: criticalROB classification: lowROB missing: criticalROB mesure: criticalROB reporting: moderate Viinikainen (Carbamazepine) b, 2006Viinikainen, 2006 7 1.00[0.12; 8.42]4132%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: moderateROB mesure: lowROB reporting: moderate Adab (Carbamazepine), 2004Adab, 2004 8 0.63[0.30; 1.33]426115%ROB confusion: criticalROB selection: criticalROB classification: lowROB missing: criticalROB mesure: moderateROB reporting: moderate Katz (Carbamazepine), 2001Katz, 2001 9 1.36[0.06; 33.80]4211%ROB confusion: criticalROB selection: criticalROB classification: lowROB missing: lowROB mesure: moderateROB reporting: moderate Van der Pol (Carbamazepine) (Controls unexposed, sick), 1991Van der Pol, 1991 10 0.16[0.01; 3.18]5101%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Total (10 studies) I2 = 17% 1.46[1.05; 2.03]10,5944,1180.010.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Carbamazepine) (Controls unexposed, sick) (Mixed indications; 2: Carbamazepine) (Controls unexposed, NOS) (Mixed indications; 3: Carbamazepine) (Controls unexposed, sick; 4: Carbamazepine; 5: Carbamazepine) (Controls unexposed, sick; 6: Carbamazepine) (Controls unexposed, sick; 7: Carbamazepine) ; 8: Carbamazepine; 9: Carbamazepine; 10: Carbamazepine) (Controls unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.46[1.05; 2.03]10,5944,11817%NABjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022 Coste (Carbamazepine) (Controls unexposed, NOS) (Mixed indications), 2020 Charlton (Carbamazepine) (Controls unexposed, sick), 2017 Arkilo (Carbamazepine), 2015 Bromley (Carbamazepine) (Controls unexposed, sick), 2013 Dean (Carbamazepine) (Controls unexposed, sick), 2007 Viinikainen (Carbamazepine) b, 2006 Adab (Carbamazepine), 2004 Katz (Carbamazepine), 2001 Van der Pol (Carbamazepine) (Controls unexposed, sick), 1991 10 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 2.00[0.99; 4.05]9,957468 -NACoste (Carbamazepine) (Controls unexposed, NOS) (Mixed indications), 2020 1 unexposed, sickunexposed, sick 1.31[0.79; 2.17]6283,61538%NABjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022 Charlton (Carbamazepine) (Controls unexposed, sick), 2017 Bromley (Carbamazepine) (Controls unexposed, sick), 2013 Dean (Carbamazepine) (Controls unexposed, sick), 2007 Viinikainen (Carbamazepine) b, 2006 Adab (Carbamazepine), 2004 Van der Pol (Carbamazepine) (Controls unexposed, sick), 1991 7 exposed to other treatment, sickexposed to other treatment, sick 2.27[0.43; 11.89]9350%NAArkilo (Carbamazepine), 2015 Katz (Carbamazepine), 2001 2 Tags Adjustment   - No  - No 1.36[0.91; 2.05]6373,65021%NABjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022 Charlton (Carbamazepine) (Controls unexposed, sick), 2017 Arkilo (Carbamazepine), 2015 Bromley (Carbamazepine) (Controls unexposed, sick), 2013 Dean (Carbamazepine) (Controls unexposed, sick), 2007 Viinikainen (Carbamazepine) b, 2006 Adab (Carbamazepine), 2004 Katz (Carbamazepine), 2001 Van der Pol (Carbamazepine) (Controls unexposed, sick), 1991 9   - Yes  - Yes 2.00[0.99; 4.05]9,957468 -NACoste (Carbamazepine) (Controls unexposed, NOS) (Mixed indications), 2020 1 Controls   - epilepsy indication  - epilepsy indication 1.50[1.20; 1.87]5423,256 -NABjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022 1 All studiesAll studies 1.46[1.05; 2.03]10,5944,11817%NABjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022 Coste (Carbamazepine) (Controls unexposed, NOS) (Mixed indications), 2020 Charlton (Carbamazepine) (Controls unexposed, sick), 2017 Arkilo (Carbamazepine), 2015 Bromley (Carbamazepine) (Controls unexposed, sick), 2013 Dean (Carbamazepine) (Controls unexposed, sick), 2007 Viinikainen (Carbamazepine) b, 2006 Adab (Carbamazepine), 2004 Katz (Carbamazepine), 2001 Van der Pol (Carbamazepine) (Controls unexposed, sick), 1991 100.010.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.94.31.9810.000Bjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022Coste (Carbamazepine) (Controls unexposed, NOS) (Mixed indications), 2020Charlton (Carbamazepine) (Controls unexposed, sick), 2017Arkilo (Carbamazepine), 2015Bromley (Carbamazepine) (Controls unexposed, sick), 2013Dean (Carbamazepine) (Controls unexposed, sick), 2007Viinikainen (Carbamazepine) b, 2006Adab (Carbamazepine), 2004Katz (Carbamazepine), 2001Van der Pol (Carbamazepine) (Controls unexposed, sick), 1991

Asymetry test p-value = 0.8395 (by Egger's regression)

slope=0.4113 (0.1554); intercept=-0.1037 (0.4957); t=0.2092; p=0.8395

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 9740, 9660, 9696, 9699, 9703, 9704, 12749, 12748

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.62[1.35; 1.96]78,4293,9320%NABjørk (Carbamazepine) (Controls unexposed NOS) (Mixed indications), 2022 Coste (Carbamazepine) (Controls unexposed, NOS) (Mixed indications), 2020 Charlton (Carbamazepine) (Controls unexposed, disease free), 2017 Bromley (Carbamazepine) (Controls unexposed, disease free), 2013 Van der Pol (Carbamazepine) (Controls unexposed, disease free), 1991 5 unexposed, sick controlsunexposed, sick controls 1.31[0.79; 2.17]6283,61538%NABjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022 Charlton (Carbamazepine) (Controls unexposed, sick), 2017 Bromley (Carbamazepine) (Controls unexposed, sick), 2013 Dean (Carbamazepine) (Controls unexposed, sick), 2007 Viinikainen (Carbamazepine) b, 2006 Adab (Carbamazepine), 2004 Van der Pol (Carbamazepine) (Controls unexposed, sick), 1991 7 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.84[1.42; 2.38]2663,5660%NABjørk (Carbamazepine) (Controls exposed to Lamotrigine, sick) (Mixed indications), 2022 Charlton (Carbamazepine) (Controls exposed to Lamotrigine, sick), 2017 Arkilo (Carbamazepine), 2015 Bromley (Carbamazepine) (Controls exposed to Lamotrigine, sick), 2013 Dean (Carbamazepine) (Controls exposed to Lamotrigine, sick), 2007 Katz (Carbamazepine), 2001 60.510.01.0