Lamotrigine (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.
S12727
R48014
Bjørk (Lamotrigine) (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 1.13 [0.91;1.40]
excluded (control group)
82/7,950   38,437/4,463,879 38,519 7,950
ref
S12728
R48015
Bjørk (Lamotrigine) (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 0.83 [0.65;1.07] C 82/7,950   267/21,634 349 7,950
ref
S8978
R39746
Coste (Lamotrigine) (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 1.30 [0.70;2.40] 10/2,813   4,254/1,707,707 4,264 2,813
ref
S8956
R39728
Wiggs (Lamotrigine), 2020 Austism Spectrum Disorder (after 2 years of age) at least 1st trimester population based cohort retrospective unexposed, sick Adjustment: Yes 0.66 [0.27;1.58] -/-   -/11,298 - -
ref
S9931
R39727
Bjørk (Lamotrigine) (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 2.05 [1.13;3.72] C
excluded (control group)
13/76   6,907/75,497 6,920 76
ref
S9973
R39726
Bjørk (Lamotrigine) (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 1.87 [0.91;3.84] C 13/76   27/272 40 76
ref
S8941
R39754
Cohen-Israel (Lamotrigine), 2018 Autism (a majority between 6-12 years old) 1st trimester retrospective cohort unexposed, disease free Adjustment: No Matched 0.33 [0.01;8.20] C 0/83   1/83 1 83
ref
S8933
R39739
Bromley (Lamotrigine) (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 1.81 [0.20;16.76] C
excluded (control group)
1/30   4/214 5 30
ref
S8936
R39743
Bromley (Lamotrigine) (Controls unexposed, sick), 2013 Autistic Spectrum Disorders (at 6 years old) during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No 2.68 [0.10;68.88] C 1/30   0/26 1 30
ref
Total 6 studies 1.02 [0.72;1.45] 4,655 10,952
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 0.83[0.65; 1.07]3497,95047%ROB confusion: unclearROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Coste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020Coste, 2020 2 1.30[0.70; 2.40]4,2642,81321%ROB confusion: moderateROB selection: moderateROB classification: criticalROB missing: moderateROB mesure: criticalROB reporting: moderate Wiggs (Lamotrigine), 2020Wiggs, 2020 3 0.66[0.27; 1.58]--12%ROB confusion: seriousROB selection: lowROB classification: lowROB missing: moderateROB mesure: moderateROB reporting: moderate Bjørk (Lamotrigine) (Controls unexposed, sick), 2018Bjørk, 2018 4 1.87[0.91; 3.84]407617%ROB confusion: unclearROB selection: lowROB classification: lowROB missing: lowROB mesure: moderateROB reporting: moderate Cohen-Israel (Lamotrigine), 2018Cohen-Israel, 2018 5 0.33[0.01; 8.20]1831%ROB confusion: criticalROB selection: moderateROB classification: criticalROB missing: unclearROB mesure: criticalROB reporting: moderate Bromley (Lamotrigine) (Controls unexposed, sick), 2013Bromley, 2013 6 2.68[0.10; 68.88]1301%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: moderateROB mesure: moderateROB reporting: moderate Total (6 studies) I2 = 28% 1.02[0.72; 1.45]4,65510,9520.210.01.0ROB: 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; 4: Lamotrigine) (Controls unexposed, sick; 5: Lamotrigine; 6: Lamotrigine) (Controls unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.02[0.72; 1.45]4,65510,95228%NABjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022 Coste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020 Wiggs (Lamotrigine), 2020 Bjørk (Lamotrigine) (Controls unexposed, sick), 2018 Cohen-Israel (Lamotrigine), 2018 Bromley (Lamotrigine) (Controls unexposed, sick), 2013 6 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.24[0.68; 2.27]4,2652,8960%NACoste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020 Cohen-Israel (Lamotrigine), 2018 2 unexposed, sickunexposed, sick 1.01[0.62; 1.64]3908,05643%NABjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022 Wiggs (Lamotrigine), 2020 Bjørk (Lamotrigine) (Controls unexposed, sick), 2018 Bromley (Lamotrigine) (Controls unexposed, sick), 2013 4 Tags Adjustment   - No  - No 1.11[0.60; 2.04]3918,13942%NABjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022 Bjørk (Lamotrigine) (Controls unexposed, sick), 2018 Cohen-Israel (Lamotrigine), 2018 Bromley (Lamotrigine) (Controls unexposed, sick), 2013 4   - Yes  - Yes 1.00[0.52; 1.91]4,2642,81334%NACoste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020 Wiggs (Lamotrigine), 2020 2 Controls   - epilepsy indication  - epilepsy indication 0.83[0.65; 1.07]3497,950 -NABjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022 1 MatchedMatched 0.33[0.01; 8.20]183 -NACohen-Israel (Lamotrigine), 2018 1 All studiesAll studies 1.02[0.72; 1.45]4,65510,95228%NABjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022 Coste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020 Wiggs (Lamotrigine), 2020 Bjørk (Lamotrigine) (Controls unexposed, sick), 2018 Cohen-Israel (Lamotrigine), 2018 Bromley (Lamotrigine) (Controls unexposed, sick), 2013 60.110.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-3.93.91.9870.000Bjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022Coste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020Wiggs (Lamotrigine), 2020Bjørk (Lamotrigine) (Controls unexposed, sick), 2018Cohen-Israel (Lamotrigine), 2018Bromley (Lamotrigine) (Controls unexposed, sick), 2013

Asymetry test p-value = 0.5379 (by Egger's regression)

slope=-0.1772 (0.2081); intercept=0.5281 (0.7848); t=0.6729; p=0.5379

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 8933, 9931, 12727

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.24[1.00; 1.54]49,70910,9524%NABjørk (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2022 Coste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020 Bjørk (Lamotrigine) (Controls unexposed, disease free), 2018 Cohen-Israel (Lamotrigine), 2018 Bromley (Lamotrigine) (Controls unexposed, disease free), 2013 5 unexposed, sick controlsunexposed, sick controls 1.01[0.62; 1.64]3908,05643%NABjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022 Wiggs (Lamotrigine), 2020 Bjørk (Lamotrigine) (Controls unexposed, sick), 2018 Bromley (Lamotrigine) (Controls unexposed, sick), 2013 40.510.01.0

Umbrella review (other published meta-analyses)

Published MATE95% CIn exposedkI2Control groupExposition period Veroniki (NMA)Veroniki (NMA) 8.88[1.29; 112.00]-whatever (meta-analysis)1st trimesterstudies-9 Veroniki (MA)Veroniki (MA) Out of scale13.77[2.06; 188.00]-whatever (meta-analysis)1st trimesterstudies2 metaPregmetaPreg 1.02[0.72; 1.45]28%10,952--Bjørk (Lamotrigine) (Controls unexposed, sick) (Mixed indications), 2022 Coste (Lamotrigine) (Controls unexposed NOS) (Mixed indications), 2020 Wiggs (Lamotrigine), 2020 Bjørk (Lamotrigine) (Controls unexposed, sick), 2018 Cohen-Israel (Lamotrigine), 2018 Bromley (Lamotrigine) (Controls unexposed, sick), 2013 60.510.01.0