The efficacy and safety of tenecteplase versus alteplase for acute ischemic stroke: an updated systematic review, pairwise, and network meta-analysis of randomized controlled trials

被引:31
作者
Abuelazm, Mohamed [1 ]
Seri, Amith Reddy [2 ,3 ]
Awad, Ahmed. K. K. [4 ]
Ahmad, Unaiza [5 ]
Mahmoud, Abdelrahman [6 ]
Albazee, Ebraheem [7 ]
Kambalapalli, Soumya [2 ,3 ]
Abdelazeem, Basel [2 ,3 ]
机构
[1] Tanta Univ, Fac Med, Tanta, Egypt
[2] McLaren Hlth Care, Dept Internal Med, Flint, MI USA
[3] Michigan State Univ, Dept Internal Med, E Lansing, MI USA
[4] Ain Shams Univ, Fac Med, Cairo, Egypt
[5] Punjab Med Coll, Faisalabad, Pakistan
[6] Minia Univ, Fac Med, Al Minya, Egypt
[7] Kuwait Inst Med Specializat KIMS, Kuwait, Kuwait
关键词
Tenecteplase; Alteplase; Stroke; TNK; AIS; Acute ischemic stroke; Systematic review; Meta-analysis; Clinical trials; TISSUE-PLASMINOGEN ACTIVATOR; BLINDED END-POINT; OPEN-LABEL; NOR-TEST; THROMBOLYSIS; RECANALIZATION; MANAGEMENT; THROMBECTOMY; GUIDELINES; PHASE-2;
D O I
10.1007/s11239-022-02730-5
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Tenecteplase (TNK) is a promising candidate to replace alteplase as the standard of care for acute ischemic stroke (AIS); however, the optimal dosage is still to be investigated. Therefore, we aim to evaluate the safety and efficacy of TNK versus alteplase and to investigate the optimal TNK dosage. A systematic review, pairwise, and network meta-analysis synthesizing randomized controlled trials (RCTs) from WOS, SCOPUS, EMBASE, and PubMed until July 26(th), 2022. We used the risk ratio (RR) for dichotomous outcomes presented with the corresponding 95% confidence interval (CI). We registered our protocol in PROSPERO with ID: CRD42022352038. Nine RCTs with a total of 3,707 patients were included. TNK significantly led to complete recanalization (RR: 1.27 with 95% CI [1.02, 1.57], P = 0.03); however, we found no difference regarding early neurological improvement (RR: 1.07 with 95% CI [0.94, 1.21], P = 0.33) and excellent neurological recovery (RR: 1.03 with 95% CI [0.96, 1.10], P = 0.42). Also, TNK was similar to alteplase regarding mortality (RR: 0.99 with 95% CI [0.82, 1.18], P = 0.88), intracranial haemorrhage (RR: 1.00 with 95% CI [0.85, 1.18], P = 0.99), and parenchymal hematoma (RR: 1.13 with 95% CI [0.83, 1.54], P = 0.44). TNK in the dose of 0.25 mg is a viable candidate to displace alteplase as the standard of care in patients with an AIS within 4.5 h of presentation due to its better rate of early neurological recovery and non-inferiority in terms of safety outcomes. However, the evidence regarding TNK's role in AIS presenting after 4.5 h from symptoms onset, wake-up stroke, and minor stroke/TIA is still lacking, necessitating further double-blinded pragmatic RCTs in this regard.
引用
收藏
页码:322 / 338
页数:17
相关论文
共 54 条
[1]  
[Anonymous], 2015, A randomized, controlled trial on the efficacy and safety of live-attenuated influenza vaccine (LAIV) among children in Bangladesh
[2]  
[Anonymous], 2022, OV STROK TRANS ISCH
[3]  
Benjamin EJ, 2017, CIRCULATION, V135, pE146, DOI [10.1161/CIR.0000000000000558, 10.1161/CIR.0000000000000485, 10.1161/CIR.0000000000000530]
[4]   European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke [J].
Berge, Eivind ;
Whiteley, William ;
Audebert, Heinrich ;
Marchis, Gian Marco De ;
Fonseca, Ana Catarina ;
Padiglioni, Chiara ;
Ossa, Natalia Perez de la ;
Strbian, Daniel ;
Tsivgoulis, Georgios ;
Turc, Guillaume .
EUROPEAN STROKE JOURNAL, 2021, 6 (01) :I-LXII
[5]   Low Rates of Acute Recanalization With Intravenous Recombinant Tissue Plasminogen Activator in Ischemic Stroke Real-World Experience and a Call for Action [J].
Bhatia, Rohit ;
Hill, Michael D. ;
Shobha, Nandavar ;
Menon, Bijoy ;
Bal, Simerpreet ;
Kochar, Puneet ;
Watson, Tim ;
Goyal, Mayank ;
Demchuk, Andrew M. .
STROKE, 2010, 41 (10) :2254-2258
[6]   Comparison of tenecteplase with alteplase for the early treatment of ischaemic stroke in the Melbourne Mobile Stroke Unit (TASTE-A): a phase 2, randomised, open-label trial [J].
Bivard, Andrew ;
Zhao, Henry ;
Churilov, Leonid ;
Campbell, Bruce C., V ;
Coote, Skye ;
Yassi, Nawaf ;
Yan, Bernard ;
Valente, Michael ;
Sharobeam, Angelos ;
Balabanski, Anna H. ;
Dos Santos, Angela ;
Ng, Jo Lyn ;
Yogendrakumar, Vignan ;
Ng, Felix ;
Langenberg, Francesca ;
Easton, Damien ;
Warwick, Alex ;
Mackey, Elizabeth ;
MacDonald, Amy ;
Sharma, Gagan ;
Stephenson, Michael ;
Smith, Karen ;
Anderson, David ;
Choi, Philip ;
Thijs, Vincent ;
Ma, Henry ;
Cloud, Geoffrey C. ;
Wijeratne, Tissa ;
Olenko, Liudmyla ;
Italiano, Dominic ;
Davis, Stephen M. ;
Donnan, Geoffrey A. ;
Parsons, Mark W. .
LANCET NEUROLOGY, 2022, 21 (06) :520-527
[7]   Tenecteplase in ischemic stroke offers improved recanalization Analysis of 2 trials [J].
Bivard, Andrew ;
Huang, Xuya ;
Levi, Christopher R. ;
Spratt, Neil ;
Campbell, Bruce C. V. ;
Cheripelli, Bharath Kumar ;
Kalladka, Dheeraj ;
Moreton, Fiona Catherine ;
Ford, Ian ;
Bladin, Christopher F. ;
Davis, Stephen M. ;
Donnan, Geoffrey A. ;
Muir, Keith W. ;
Parsons, Mark W. .
NEUROLOGY, 2017, 89 (01) :62-67
[8]   Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018 [J].
Boulanger, J. M. ;
Lindsay, M. P. ;
Gubitz, G. ;
Smith, E. E. ;
Stotts, G. ;
Foley, N. ;
Bhogal, S. ;
Boyle, K. ;
Braun, L. ;
Goddard, T. ;
Heran, M. K. S. ;
Kanya-Forster, N. ;
Lang, E. ;
Lavoie, P. ;
McClelland, M. ;
O'Kelly, C. ;
Pageau, P. ;
Pettersen, J. ;
Purvis, H. ;
Shamy, M. ;
Tampieri, D. ;
vanAdel, B. ;
Verbeek, R. ;
Blacquiere, D. ;
Casaubon, L. ;
Ferguson, D. ;
Hegedus, Y. ;
Jacquin, G. J. ;
Kelly, M. ;
Kamal, N. ;
Linkewich, B. ;
Lum, C. ;
Mann, B. ;
Milot, G. ;
Newcommon, N. ;
Poirier, P. ;
Simpkin, W. ;
Snieder, E. ;
Trivedi, A. ;
Whelan, R. ;
Eustace, M. ;
Smitko, E. ;
Butcher, K. .
INTERNATIONAL JOURNAL OF STROKE, 2018, 13 (09) :949-984
[9]   Evidence that Tenecteplase Is Noninferior to Alteplase for Acute Ischemic Stroke: Meta-Analysis of 5 Randomized Trials [J].
Burgos, Adrian M. ;
Saver, Jeffrey L. .
STROKE, 2019, 50 (08) :2156-2162
[10]   Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke [J].
Campbell, B. C. V. ;
Mitchell, P. J. ;
Churilov, L. ;
Yassi, N. ;
Kleinig, T. J. ;
Dowling, R. J. ;
Yan, B. ;
Bush, S. J. ;
Dewey, H. M. ;
Thijs, V. ;
Scroop, R. ;
Simpson, M. ;
Brooks, M. ;
Asadi, H. ;
Wu, T. Y. ;
Shah, D. G. ;
Wijeratne, T. ;
Ang, T. ;
Miteff, F. ;
Levi, C. R. ;
Rodrigues, E. ;
Zhao, H. ;
Salvaris, P. ;
Garcia-Esperon, C. ;
Bailey, P. ;
Rice, H. ;
de Villiers, L. ;
Brown, H. ;
Redmond, K. ;
Leggett, D. ;
Fink, J. N. ;
Collecutt, W. ;
Wong, A. A. ;
Muller, C. ;
Coulthard, A. ;
Mitchell, K. ;
Clouston, J. ;
Mahady, K. ;
Field, D. ;
Ma, H. ;
Phan, T. G. ;
Chong, W. ;
Chandra, R. V. ;
Slater, L. -A. ;
Krause, M. ;
Harrington, T. J. ;
Faulder, K. C. ;
Steinfort, B. S. ;
Bladin, C. F. ;
Sharma, G. .
NEW ENGLAND JOURNAL OF MEDICINE, 2018, 378 (17) :1573-1582