Carbamazepine (All indications)

ASD (Autism spectrum disorder): Diagnosis/Risk

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
R48754
Bjørk (Carbamazepine) (Controls exposed to Lamotrigine, sick) (Mixed indications), 2022 Diagnosis of childhood autism (F84.0), atypical autism (F84.1), and Asperger syndrome (F84.5) (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 1.22 [0.84;1.78] C
excluded (control group)
41/3,256   82/7,950 123 3,256
ref
S12748
R48755
Bjørk (Carbamazepine) (Controls unexposed NOS) (Mixed indications), 2022 Diagnosis of childhood autism (F84.0), atypical autism (F84.1), and Asperger syndrome (F84.5) (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 1.36 [1.00;1.85]
excluded (control group)
41/3,256   38,437/4,463,879 38,478 3,256
ref
S12747
R48756
Bjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022 Diagnosis of childhood autism (F84.0), atypical autism (F84.1), and Asperger syndrome (F84.5) (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 1.02 [0.73;1.42] C 41/3,256   267/21,634 308 3,256
ref
S9776
R46383
Coste (Carbamazepine) (Controls exposed to Lamotrigine, sick) (Mixed indications), 2020 Diagnosis Pervasive developmental disorders (F84) (mean age of 3.7 years old) during pregnancy (anytime or not specified) retrospective cohort (claims database) exposed to other treatment, sick excluded Adjustment: Yes 1.30 [0.30;5.00]
excluded (control group)
3/502   11/2,916 14 502
ref
S9777
R46384
Coste (Carbamazepine) (Controls unexposed, NOS) (Mixed indications), 2020 Diagnosis Pervasive developmental disorders (F84) (mean age of 3.6 years old) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes 1.70 [0.50;5.20] 3/468   4,254/1,707,707 4,257 468
ref
S9749
R46387
Wiggs (Carbamazepine), 2020 Austism Spectrum Disorder (after 2 years of age) at least 1st trimester population based cohort retrospective unexposed, sick Adjustment: Yes 1.26 [0.88;1.79] -/-   -/11,298 - -
ref
S9723
R46386
Huber-Mollema (Carbamazepine), 2019 Diagnosis of autism spectrum disorder throughout pregnancy prospective cohort exposed to other treatment, sick Adjustment: No 1.20 [0.21;6.85] C 2/37   4/88 6 37
ref
S9975
R46389
Bjørk (Carbamazepine) (Controls exposed to Lamotrigine, sick), 2018 Autistic traits at 18 months and/or at 36 months (M-CHAT <2/6 critical or <3/23 or SCQ >13) during pregnancy (anytime or not specified) population based cohort propective exposed to other treatment, sick excluded Adjustment: No 0.83 [0.29;2.38] C
excluded (control group)
6/41   13/76 19 41
ref
S9976
R46390
Bjørk (Carbamazepine) (Controls unexposed, disease free), 2018 Autistic traits at 18 months and/or at 36 months (M-CHAT <2/6 critical or <3/23 or SCQ >13) during pregnancy (anytime or not specified) population based cohort propective unexposed, disease free excluded Adjustment: No 1.70 [0.72;4.05] C
excluded (control group)
6/41   6,907/75,497 6,913 41
ref
S9977
R46391
Bjørk (Carbamazepine) (Controls unexposed, sick), 2018 Autistic traits at 18 months and/or at 36 months (M-CHAT <2/6 critical or <3/23 or SCQ >13) during pregnancy (anytime or not specified) population based cohort propective unexposed, sick Adjustment: No 1.56 [0.60;4.03] C 6/41   27/272 33 41
ref
S9750
R46388
Wood (Carbamazepine), 2015 Score >30 (CARS) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick Adjustment: No 0.78 [0.03;21.03] C 1/34   0/9 1 34
ref
S9696
R46378
Bromley (Carbamazepine) (Controls exposed to Lamotrigine, sick), 2013 Autistic Spectrum Disorders (at 6 years old) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick excluded Adjustment: No 0.19 [0.01;4.87] C
excluded (control group)
0/50   1/30 1 50
ref
S9699
R46379
Bromley (Carbamazepine) (Controls unexposed, disease free), 2013 Autistic Spectrum Disorders (at 6 years old) during pregnancy (anytime or not specified) prospective cohort unexposed, disease free excluded Adjustment: No 0.47 [0.02;8.88] C
excluded (control group)
0/50   4/214 4 50
ref
S9702
R46380
Bromley (Carbamazepine) (Controls unexposed, sick), 2013 Autistic Spectrum Disorders (at 6 years old) during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No 0.52 [0.01;26.73] C 0/50   0/26 0 50
ref
Total 7 studies 1.16 [0.92;1.46] 4,605 3,886
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 1.02[0.73; 1.42]3083,25647%ROB confusion: unclearROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Coste (Carbamazepine) (Controls unexposed, NOS) (Mixed indications), 2020Coste, 2020 2 1.70[0.50; 5.20]4,2574684%ROB confusion: moderateROB selection: moderateROB classification: criticalROB missing: moderateROB mesure: criticalROB reporting: moderate Wiggs (Carbamazepine), 2020Wiggs, 2020 3 1.26[0.88; 1.79]--41%ROB confusion: moderateROB selection: lowROB classification: lowROB missing: moderateROB mesure: moderateROB reporting: moderate Huber-Mollema (Carbamazepine), 2019Huber-Mollema, 2019 4 1.20[0.21; 6.85]6372%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: criticalROB mesure: moderateROB reporting: moderate Bjørk (Carbamazepine) (Controls unexposed, sick), 2018Bjørk, 2018 5 1.56[0.60; 4.03]33416%ROB confusion: unclearROB selection: lowROB classification: lowROB missing: lowROB mesure: moderateROB reporting: moderate Wood (Carbamazepine), 2015Wood, 2015 6 0.78[0.03; 21.03]1340%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: criticalROB mesure: lowROB reporting: moderate Bromley (Carbamazepine) (Controls unexposed, sick), 2013Bromley, 2013 7 0.52[0.01; 26.73]0500%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: moderateROB mesure: moderateROB reporting: moderate Total (7 studies) I2 = 0% 1.16[0.92; 1.46]4,6053,8860.25.01.0ROB: 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; 4: Carbamazepine; 5: Carbamazepine) (Controls unexposed, sick; 6: Carbamazepine; 7: Carbamazepine) (Controls unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.16[0.92; 1.46]4,6053,8860%NABjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022 Coste (Carbamazepine) (Controls unexposed, NOS) (Mixed indications), 2020 Wiggs (Carbamazepine), 2020 Huber-Mollema (Carbamazepine), 2019 Bjørk (Carbamazepine) (Controls unexposed, sick), 2018 Wood (Carbamazepine), 2015 Bromley (Carbamazepine) (Controls unexposed, sick), 2013 7 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.70[0.53; 5.48]4,257468 -NACoste (Carbamazepine) (Controls unexposed, NOS) (Mixed indications), 2020 1 unexposed, sickunexposed, sick 1.14[0.91; 1.45]3413,3470%NABjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022 Wiggs (Carbamazepine), 2020 Bjørk (Carbamazepine) (Controls unexposed, sick), 2018 Bromley (Carbamazepine) (Controls unexposed, sick), 2013 4 exposed to other treatment, sickexposed to other treatment, sick 1.09[0.23; 5.10]7710%NAHuber-Mollema (Carbamazepine), 2019 Wood (Carbamazepine), 2015 2 Tags Adjustment   - No  - No 1.06[0.78; 1.44]3483,4180%NABjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022 Huber-Mollema (Carbamazepine), 2019 Bjørk (Carbamazepine) (Controls unexposed, sick), 2018 Wood (Carbamazepine), 2015 Bromley (Carbamazepine) (Controls unexposed, sick), 2013 5   - Yes  - Yes 1.29[0.92; 1.81]4,2574680%NACoste (Carbamazepine) (Controls unexposed, NOS) (Mixed indications), 2020 Wiggs (Carbamazepine), 2020 2 Controls   - epilepsy indication  - epilepsy indication 1.02[0.73; 1.42]3083,256 -NABjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022 1 All studiesAll studies 1.16[0.92; 1.46]4,6053,8860%NABjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022 Coste (Carbamazepine) (Controls unexposed, NOS) (Mixed indications), 2020 Wiggs (Carbamazepine), 2020 Huber-Mollema (Carbamazepine), 2019 Bjørk (Carbamazepine) (Controls unexposed, sick), 2018 Wood (Carbamazepine), 2015 Bromley (Carbamazepine) (Controls unexposed, sick), 2013 70.25.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-4.74.92.4180.000Bjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022Coste (Carbamazepine) (Controls unexposed, NOS) (Mixed indications), 2020Wiggs (Carbamazepine), 2020Huber-Mollema (Carbamazepine), 2019Bjørk (Carbamazepine) (Controls unexposed, sick), 2018Wood (Carbamazepine), 2015Bromley (Carbamazepine) (Controls unexposed, sick), 2013

Asymetry test p-value = 0.7547 (by Egger's regression)

slope=0.1225 (0.1054); intercept=0.1135 (0.3439); t=0.3301; p=0.7547

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 9696, 9699, 9975, 9976, 9776, 12749, 12748

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.40[1.06; 1.85]49,6523,8150%NABjørk (Carbamazepine) (Controls unexposed NOS) (Mixed indications), 2022 Coste (Carbamazepine) (Controls unexposed, NOS) (Mixed indications), 2020 Bjørk (Carbamazepine) (Controls unexposed, disease free), 2018 Bromley (Carbamazepine) (Controls unexposed, disease free), 2013 4 unexposed, sick controlsunexposed, sick controls 1.14[0.91; 1.45]3413,3470%NABjørk (Carbamazepine) (Controls unexposed, sick) (Mixed indications), 2022 Wiggs (Carbamazepine), 2020 Bjørk (Carbamazepine) (Controls unexposed, sick), 2018 Bromley (Carbamazepine) (Controls unexposed, sick), 2013 4 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.15[0.82; 1.61]1643,9200%NABjørk (Carbamazepine) (Controls exposed to Lamotrigine, sick) (Mixed indications), 2022 Coste (Carbamazepine) (Controls exposed to Lamotrigine, sick) (Mixed indications), 2020 Huber-Mollema (Carbamazepine), 2019 Bjørk (Carbamazepine) (Controls exposed to Lamotrigine, sick), 2018 Wood (Carbamazepine), 2015 Bromley (Carbamazepine) (Controls exposed to Lamotrigine, sick), 2013 60.510.01.0