Abstract
Purpose
The 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.
Methods
The 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.
Findings
Totals 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).
Implications
Based 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.
Key words
Abbreviations:
IV (Intravenouss), RCT (randomized controlled trial)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical TherapeuticsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Heart disease and stroke statistics—2015 update: a report from the American Heart Association.Circulation. 2015; 131: e29-322
- The high cost of stroke and stroke cytoprotection research.Translational Stroke Res. 2016; 8: 307-317
- Stroke. Lancet. 2017; 389: 641-654
- Intravenous magnesium sulfate in acute stroke.Stroke. 2019; 50: 931-938
- Citicoline for treating people with acute ischemic stroke.Cochrane Database Syst Rev. 2020; 8CD013066
- Neuroprotection for ischaemic stroke: translation from the bench to the bedside.Int J Stroke. 2012; 7: 407-418
- Free radical trapping as a therapeutic approach to neuroprotection in stroke: experimental and clinical studies with NXY-059 and free radical scavengers.Curr Drug Targets CNS Neurol Disord. 2005; 4: 109-118
- Edaravone's free radical scavenging mechanisms of neuroprotection against cerebral ischemia: review of the literature.Int J Neurosci. 2015; 125: 555-565
- Outline of the Japanese Guidelines for the Management of Stroke 2004 and subsequent revision.Int J Stroke. 2008; 3: 55-62
- 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2018; 49: e46-110
- Edaravone for acute ischaemic stroke.Cochrane Database Syst Rev. 2011; (Cd007230)
- Edaravone for acute stroke: meta-analyses of data from randomized controlled trials.Dev Neurorehabil. 2015; 18: 330-335
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.BMJ (Clin Res Ed). 2009; 339: b2535
- The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.BMJ (Clin Res Ed). 2011; 343: d5928
- Effect of a novel free radical scavenger, edaravone (MCI-186), on acute brain infarction. Randomized, placebo-controlled, double-blind study at multicenters.Cerebrovasc Dis (Basel, Switzerland). 2003; 15: 222-229
- A randomized controlled clinical trial to compare the safety and efficacy of edaravone in acute ischemic stroke.Ann Indian Acad Neurol. 2011; 14: 103-106
- Edaravone—citicoline comparative study in acute ischemic stroke (ECCS-AIS).J Assoc Physicians India. 2012; 60: 36-38
- Safety, tolerability and pharmacokinetics of MCI-186 in patients with acute ischemic stroke: new formulation and dosing regimen.Cerebrovasc Dis (Basel, Switzerland). 2013; 36: 196-204
- Edaravone offers neuroprotection for acute diabetic stroke patients.Irish J Med Sci. 2016; 185: 819-824
- Clinical observation in edaravone treatment for acute cerebral infarction.Nigerian J Clin Pract. 2019; 22: 1324-1327
- Effects of edaravone on neurological function and tumor necrosis factor alpha and interleukin 8 levels in patients with cerebral infarction.Eur Neurol. 2020; 83: 73-79
- The clinical efficacy and safety of edaravone combined with gm1 in the treatment of the elderly patients with cerebral infarction.Int J Clin Exp Med. 2017; 10: 1199-1204
- Effects of intravenous thrombolysis with alteplase combined with edaravone on cerebral hemodynamics and T lymphocyte level in patients with acute cerebral infarction.Medicine. 2020; 99: e23414
- Effects of edaravone, the free radical scavenger, on outcomes in acute cerebral infarction patients treated with ultra-early thrombolysis of recombinant tissue plasminogen activator.Clin Neurol Neurosurg. 2018; 167: 157-161
- Tissue plasminogen activator thrombolytic therapy for acute ischemic stroke in 4 hospital groups in Japan.J Stroke Cerebrovasc Dis. 2013; 22: 190-196
- Effects of edaravone on early outcomes in acute ischemic stroke patients treated with recombinant tissue plasminogen activator.J Neurol Sci. 2014; 345: 106-111
- Intravenous thrombolysis with neuroprotective therapy by edaravone for ischemic stroke patients older than 80 years of age.J Stroke Cerebrovasc Dis. 2013; 22: 1175-1183
- Simultaneous administration of recombinant tissue plasminogen activator and edaravone in acute cerebral ischemic stroke patients.J Stroke Cerebrovasc Dis. 2014; 23: 2748-2752
- Combination of thrombolytic therapy and neuroprotective therapy in acute ischemic stroke: is it important?.Eur Rev Med Pharmacol Sci. 2015; 19: 416-422
- Administration of edaravone, a free radical scavenger, during t-PA infusion can enhance early recanalization in acute stroke patients–a preliminary study.J Neurol Sci. 2012; 313: 132-136
- YAMATO study (Tissue-Type Plasminogen Activator and Edaravone Combination Therapy).Stroke. 2017; 48: 712-719
- Edaravone dexborneol versus edaravone alone for the treatment of acute ischemic stroke: a phase III, randomized, double-blind, comparative trial.Stroke. 2021; (Strokeaha120031197)
Article info
Publication history
Published online: December 03, 2022
Accepted:
November 8,
2022
Identification
Copyright
© 2022 Elsevier Inc.
