Edaravone for Acute Ischemic Stroke: A Systematic Review and Meta-analysis |
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| Affiliation: | 1. Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People''s Hospital (Affiliated People''s Hospital, Hangzhou Medical College), Hangzhou, China;2. Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China;3. Department of Rheumatology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China;1. Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, Massachusetts;2. Department of Pediatrics, Division of Newborn Medicine, Women & Infants Hospital of Rhode Island, Providence Rhode Island;1. SDA Bocconi School of Management, Centre for Research on Health and Social Care Management (CERGAS), Milan, Italy;2. Janssen-Cilag Italy, Milan, Italy;1. St. Joseph''s/Candler Health System Inc, Savannah, Georgia;2. Children''s Health, Children''s Medical Center Dallas, Dallas, Texas;3. College of Medicine, The University of Tennessee Health Science Center, Methodist Le Bonheur Healthcare, Memphis, Tennessee;4. University of Georgia College of Pharmacy, Savannah, Georgia;1. Clinical Society of Endocannabinology, Barcelona, Spain.;3. Nutrition and Food Science Research Group, ITESO, Jesuit University of Guadalajara, San Pedro Tlaquepaque, Jalisco, Mexico;1. Chronic Kidney Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran;2. Department of Nephrology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran;3. Medical Department, Orchid Pharmed Company, Tehran, Iran;4. Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran |
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| Abstract: | PurposeThe management of acute stroke is challenging. The aim of this meta-analysis was to determine the efficacy and tolerability of edaravone, with or without thrombolytic therapy, in the treatment of patients with acute ischemic stroke.MethodsThe PubMed, EMBASE, and Cochrane databases were searched for randomized controlled trials (RCTs) and cohort studies. Mean differences (MD), risk ratios (RR), 95% confidence interval (CI), and heterogeneity were calculated.FindingsTotals of nine RCTs and four cohort studies were included, for a total of 2102 patients. In patients with acute ischemic stroke, edaravone monotherapy was associated with significantly improved Barthel Index of functioning in activities for daily living (MD, 23.95; 95% CI, 18.48 to 29.41; P < 0.001) and neurologic deficit, (as measured using the National Institutes of Health Stroke Scale score) (MD = –3.49; 95% CI, –5.76 to 1.22; P = 0.003), on short-term follow-up. However, edaravone was not associated with an improved rate of death or disability (RR = 0.75; 95% CI, 0.45 to 1.23; P = 0.25) on long-term follow-up.When plus to thrombolytic therapy, edaravone was associated with significant improvements in recanalization rate (RR = 1.71; 95% CI, 1.05 to 2.77; P = 0.03) and neurologic deficit (MD = 3.97; 95% CI, 5.14 to 2.79; P < 0.001), without an increase in the prevalence of bleeding events (RR = 1.11; 95% CI, 0.76 to 1.62; P = 0.59). However, edaravone did not have a significant effect on death or disability (RR = 0.85; 95% CI, 0.69 to 1.04; P = 0.12).ImplicationsBased on the findings from the present meta-analysis, edaravone was an effective and well-tolerated neuroprotective agent in these patients with ischemic stroke. With the use of edaravone, activities of daily living and neurologic deficits, along with recanalization rates, were improved on short-term follow-up, but the long-term effects still need confirmation in larger-scale clinical trials. |
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