Phenytoin (All indications) updated on 04-22-2025

Severe cognitive developmental delay (Mental retardation) (> 6 years old)

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.
S17390
R72905
Madley-Dowd_SE (Phenytoin) (Controls exposed to LTG) (Mixed indications), 2024 Intellectual disability - ICD-8/9/10 codes and/or ADHD medication prescription - Mean 5-20 years old (according groups) during pregnancy (anytime or not specified) population based cohort retrospective exposed to other treatment, sick excluded Adjustment: Yes 0.61 [0.19;1.96]
excluded (control group)
-/194   60/5,035 - 194
ref
S17391
R72911
Madley-Dowd_SE (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 Intellectual disability - ICD-8/9/10 codes and/or ADHD medication prescription - Mean 5-20 years old (according groups) during pregnancy (anytime or not specified) population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes 0.67 [0.22;2.10] -/194   24,323/2,651,210 - 194
ref
S17392
R72917
Madley-Dowd_SE (Phenytoin) (Controls unexposed, sibling) (Mixed indications), 2024 Intellectual disability - ICD-8/9/10 codes and/or ADHD medication prescription - Mean 5-20 years old (according groups) during pregnancy (anytime or not specified) population based cohort retrospective sibling excluded Adjustment: Yes 0.53 [0.03;8.50]
excluded (control group)
-/-   -/- - -
ref
S17268
R72289
Madley-Dowd_UK (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 Intellectual disability - ICD10 codes - Median follow up 10.75 (7.82-13.62) years old during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No 5.04 [0.31;81.78] C 0/46   1,119/514,066 1,119 46
ref
S9266
R32135
Meador (Phenytoin), 2013 IQ <70 (DAS) (at 6 years old) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick Adjustment: Yes 1.86 [0.04;95.58] C 0/40   0/74 0 40
ref
S9269
R32147
Titze (Phenytoin) (Controls unexposed, disease free), 2008 Learning disability (IQ<70) (German versions of the revised Wechsler Intelligence Scales for children and for adults) during pregnancy (anytime or not specified) prospective cohort unexposed, disease free excluded Adjustment: No Matched 4.22 [0.08;223.98] C
excluded (control group)
0/12   0/49 0 12
ref
S9270
R32148
Titze (Phenytoin) (Controls unexposed, sick), 2008 Learning disability (IQ<70) (German versions of the revised Wechsler Intelligence Scales for children and for adults) during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No 0.33 [0.01;9.07] C 0/12   1/13 1 12
ref
Total 4 studies 0.86 [0.33;2.25] 1,120 292
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 Madley-Dowd_SE (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024Madley-Dowd_SE, 2024 1 0.67[0.22; 2.10]-19473%ROB confusion: seriousROB selection: lowROB classification: lowROB missing: lowROB mesure: criticalROB reporting: moderate Madley-Dowd_UK (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024Madley-Dowd_UK, 2024 2 5.04[0.31; 81.78]1,1194612%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: unclearROB mesure: criticalROB reporting: moderate Meador (Phenytoin), 2013Meador, 2013 3 1.86[0.04; 95.58]0406%ROB confusion: moderateROB selection: lowROB classification: lowROB missing: moderateROB mesure: lowROB reporting: low Titze (Phenytoin) (Controls unexposed, sick), 2008Titze, 2008 4 0.33[0.01; 9.07]1129%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: moderateROB mesure: moderateROB reporting: moderate Total (4 studies) I2 = 0% 0.86[0.33; 2.25]1,1202920.220.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Phenytoin) (Controls unexposed, general pop) (Mixed indications; 2: Phenytoin) (Controls unexposed, general pop) (Mixed indications; 3: Phenytoin; 4: Phenytoin) (Controls unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 0.86[0.33; 2.25]1,1202920%NAMadley-Dowd_SE (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 Madley-Dowd_UK (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 Meador (Phenytoin), 2013 Titze (Phenytoin) (Controls unexposed, sick), 2008 4 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.21[0.20; 7.29]1,11924042%NAMadley-Dowd_SE (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 Madley-Dowd_UK (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 2 unexposed, sickunexposed, sick 0.33[0.01; 9.07]112 -NATitze (Phenytoin) (Controls unexposed, sick), 2008 1 exposed to other treatment, sickexposed to other treatment, sick 1.86[0.04; 95.58]-40 -NAMeador (Phenytoin), 2013 1 Tags Adjustment   - No  - No 1.51[0.11; 21.20]1,1205834%NAMadley-Dowd_UK (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 Titze (Phenytoin) (Controls unexposed, sick), 2008 2   - Yes  - Yes 0.72[0.24; 2.14]-2340%NAMadley-Dowd_SE (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 Meador (Phenytoin), 2013 2 All studiesAll studies 0.86[0.33; 2.25]1,1202920%NAMadley-Dowd_SE (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 Madley-Dowd_UK (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 Meador (Phenytoin), 2013 Titze (Phenytoin) (Controls unexposed, sick), 2008 40.120.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-4.74.62.4120.000Madley-Dowd_SE (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024Madley-Dowd_UK (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024Meador (Phenytoin), 2013Titze (Phenytoin) (Controls unexposed, sick), 2008

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

not enought points

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 9269, 17390, 17392

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.14[0.33; 3.97]25,43325212%NAMadley-Dowd_SE (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 Madley-Dowd_UK (Phenytoin) (Controls unexposed, general pop) (Mixed indications), 2024 Titze (Phenytoin) (Controls unexposed, disease free), 2008 3 unexposed, sick controlsunexposed, sick controls Out of scale0.33[0.01; 9.07]112 -NATitze (Phenytoin) (Controls unexposed, sick), 2008 1 exposed to other treatment, sick controlsexposed to other treatment, sick controls 0.67[0.22; 2.04]512340%NAMadley-Dowd_SE (Phenytoin) (Controls exposed to LTG) (Mixed indications), 2024 Meador (Phenytoin), 2013 2 siblingssiblings 0.53[0.03; 8.92]-- -NAMadley-Dowd_SE (Phenytoin) (Controls unexposed, sibling) (Mixed indications), 2024 10.510.01.0