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

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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.

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Authors and Affiliations

  1. Medical Research Group of Egypt (MRGE), Cairo, Egypt

    Abdullah Ashraf Hamad, Amir N. Attia, Nada Mostafa Al-dardery, Shrouk F Mohamed & Mostafa Meshref

  2. Faculty of Medicine, Menoufia University, Menoufia, Egypt

    Abdullah Ashraf Hamad

  3. Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt

    Amir N. Attia

  4. Faculty of Medicine, Fayoum University, Fayoum, Egypt

    Nada Mostafa Al-dardery

  5. Faculty of Medicine, Alexandria University, Alexandria, Egypt

    Shrouk F Mohamed

  6. Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

    Mostafa Meshref

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Hamad, A.A., Attia, A.N., Al-dardery, N.M. et al. Safety and efficacy of lithium in patients with amyotrophic lateral sclerosis: a systematic review and meta-analysis of randomized controlled trials. Neurol Sci 44, 3029–3036 (2023). https://doi.org/10.1007/s10072-023-06814-9

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