Comparative efficacy and safety of tenecteplase and alteplase in acute ischemic stroke: A pairwise and network meta-analysis of randomized controlled trials
Studies on tenecteplase have been yielding mixed results for several important outcomes at different doses, thus hampering objective guideline recommendations in acute ischemic stroke management. This meta-analysis stratifies doses in order to refine our interpretation of outcomes and quantify the b...
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| Veröffentlicht in: | Journal of the neurological sciences 2023-02, Vol.445, p.120537-120537, Article 120537 |
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| creator | Rehman, Aqeeb Ur Mohsin, Aleenah Cheema, Huzaifa Ahmad Zahid, Afra Rehman, Muhammad Ebaad Ur Ameer, Muhammad Zain Ayyan, Muhammad Ehsan, Muhammad Shahid, Abia Aemaz Ur Rehman, Muhammad Shah, Jaffer Khawaja, Ayaz |
| description | Studies on tenecteplase have been yielding mixed results for several important outcomes at different doses, thus hampering objective guideline recommendations in acute ischemic stroke management. This meta-analysis stratifies doses in order to refine our interpretation of outcomes and quantify the benefits and harms of tenecteplase at different doses.
PubMed/MEDLINE, the Cochrane Library, and reference lists of the included articles were systematically searched. Several efficacy and safety outcomes were pooled and reported as risk ratios (RRs) with 95% confidence intervals (CIs). Network meta-analysis was used to find the optimal dose of tenecteplase. Meta-regression was run to investigate the impact of baseline NIHSS scores on functional outcomes and mortality.
Ten randomized controlled trials with a total of 4140 patients were included. 2166 (52.32%) patients were enrolled in the tenecteplase group and 1974 (47.68%) in the alteplase group. Tenecteplase at 0.25 mg/kg dose demonstrated significant improvement in excellent functional outcome at 3 months (RR 1.14, 95% CI 1.04–1.26), and early neurological improvement (RR 1.53, 95% CI 1.03–2.26). There was no statistically significant difference between tenecteplase and alteplase in terms of good functional outcome, intracerebral hemorrhage (ICH), symptomatic intracerebral hemorrhage (sICH), and 90-day mortality at any dose. Meta-regression demonstrated superior tenecteplase efficacy with increasing stroke severity, however, the results were statistically nonsignificant.
Tenecteplase at 0.25 mg/kg dose is more efficacious and at least as safe as alteplase for stroke thrombolysis. Newer analyses need to focus on direct comparison of tenecteplase doses and whether tenecteplase is efficacious at longer needle times.
•We assessed the comparative efficacy and safety of tenecteplase and alteplase.•We included 10 randomized controlled trials (RCTs) with 4140 participants.•Tenecteplase at 0.25 mg/kg dose is more efficacious and equally safe as alteplase.•Future RCTs should focus on direct comparison of tenecteplase dosages. |
| doi_str_mv | 10.1016/j.jns.2022.120537 |
| format | Article |
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PubMed/MEDLINE, the Cochrane Library, and reference lists of the included articles were systematically searched. Several efficacy and safety outcomes were pooled and reported as risk ratios (RRs) with 95% confidence intervals (CIs). Network meta-analysis was used to find the optimal dose of tenecteplase. Meta-regression was run to investigate the impact of baseline NIHSS scores on functional outcomes and mortality.
Ten randomized controlled trials with a total of 4140 patients were included. 2166 (52.32%) patients were enrolled in the tenecteplase group and 1974 (47.68%) in the alteplase group. Tenecteplase at 0.25 mg/kg dose demonstrated significant improvement in excellent functional outcome at 3 months (RR 1.14, 95% CI 1.04–1.26), and early neurological improvement (RR 1.53, 95% CI 1.03–2.26). There was no statistically significant difference between tenecteplase and alteplase in terms of good functional outcome, intracerebral hemorrhage (ICH), symptomatic intracerebral hemorrhage (sICH), and 90-day mortality at any dose. Meta-regression demonstrated superior tenecteplase efficacy with increasing stroke severity, however, the results were statistically nonsignificant.
Tenecteplase at 0.25 mg/kg dose is more efficacious and at least as safe as alteplase for stroke thrombolysis. Newer analyses need to focus on direct comparison of tenecteplase doses and whether tenecteplase is efficacious at longer needle times.
•We assessed the comparative efficacy and safety of tenecteplase and alteplase.•We included 10 randomized controlled trials (RCTs) with 4140 participants.•Tenecteplase at 0.25 mg/kg dose is more efficacious and equally safe as alteplase.•Future RCTs should focus on direct comparison of tenecteplase dosages.</description><identifier>ISSN: 0022-510X</identifier><identifier>EISSN: 1878-5883</identifier><identifier>DOI: 10.1016/j.jns.2022.120537</identifier><identifier>PMID: 36630803</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Alteplase ; Cerebral Hemorrhage - drug therapy ; Fibrinolytic Agents - adverse effects ; Humans ; Ischemic stroke ; Ischemic Stroke - drug therapy ; Network Meta-Analysis ; Randomized Controlled Trials as Topic ; Tenecteplase ; Tenecteplase - adverse effects ; Thrombolytic therapy ; Tissue plasminogen activator ; Tissue Plasminogen Activator - adverse effects ; Treatment Outcome</subject><ispartof>Journal of the neurological sciences, 2023-02, Vol.445, p.120537-120537, Article 120537</ispartof><rights>2022 Elsevier B.V.</rights><rights>Copyright © 2022 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-b0b4a603c20bd32336647b57f2a70f7c43646786beda4e02357db43107a318323</citedby><cites>FETCH-LOGICAL-c396t-b0b4a603c20bd32336647b57f2a70f7c43646786beda4e02357db43107a318323</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jns.2022.120537$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36630803$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rehman, Aqeeb Ur</creatorcontrib><creatorcontrib>Mohsin, Aleenah</creatorcontrib><creatorcontrib>Cheema, Huzaifa Ahmad</creatorcontrib><creatorcontrib>Zahid, Afra</creatorcontrib><creatorcontrib>Rehman, Muhammad Ebaad Ur</creatorcontrib><creatorcontrib>Ameer, Muhammad Zain</creatorcontrib><creatorcontrib>Ayyan, Muhammad</creatorcontrib><creatorcontrib>Ehsan, Muhammad</creatorcontrib><creatorcontrib>Shahid, Abia</creatorcontrib><creatorcontrib>Aemaz Ur Rehman, Muhammad</creatorcontrib><creatorcontrib>Shah, Jaffer</creatorcontrib><creatorcontrib>Khawaja, Ayaz</creatorcontrib><title>Comparative efficacy and safety of tenecteplase and alteplase in acute ischemic stroke: A pairwise and network meta-analysis of randomized controlled trials</title><title>Journal of the neurological sciences</title><addtitle>J Neurol Sci</addtitle><description>Studies on tenecteplase have been yielding mixed results for several important outcomes at different doses, thus hampering objective guideline recommendations in acute ischemic stroke management. This meta-analysis stratifies doses in order to refine our interpretation of outcomes and quantify the benefits and harms of tenecteplase at different doses.
PubMed/MEDLINE, the Cochrane Library, and reference lists of the included articles were systematically searched. Several efficacy and safety outcomes were pooled and reported as risk ratios (RRs) with 95% confidence intervals (CIs). Network meta-analysis was used to find the optimal dose of tenecteplase. Meta-regression was run to investigate the impact of baseline NIHSS scores on functional outcomes and mortality.
Ten randomized controlled trials with a total of 4140 patients were included. 2166 (52.32%) patients were enrolled in the tenecteplase group and 1974 (47.68%) in the alteplase group. Tenecteplase at 0.25 mg/kg dose demonstrated significant improvement in excellent functional outcome at 3 months (RR 1.14, 95% CI 1.04–1.26), and early neurological improvement (RR 1.53, 95% CI 1.03–2.26). There was no statistically significant difference between tenecteplase and alteplase in terms of good functional outcome, intracerebral hemorrhage (ICH), symptomatic intracerebral hemorrhage (sICH), and 90-day mortality at any dose. Meta-regression demonstrated superior tenecteplase efficacy with increasing stroke severity, however, the results were statistically nonsignificant.
Tenecteplase at 0.25 mg/kg dose is more efficacious and at least as safe as alteplase for stroke thrombolysis. Newer analyses need to focus on direct comparison of tenecteplase doses and whether tenecteplase is efficacious at longer needle times.
•We assessed the comparative efficacy and safety of tenecteplase and alteplase.•We included 10 randomized controlled trials (RCTs) with 4140 participants.•Tenecteplase at 0.25 mg/kg dose is more efficacious and equally safe as alteplase.•Future RCTs should focus on direct comparison of tenecteplase dosages.</description><subject>Alteplase</subject><subject>Cerebral Hemorrhage - drug therapy</subject><subject>Fibrinolytic Agents - adverse effects</subject><subject>Humans</subject><subject>Ischemic stroke</subject><subject>Ischemic Stroke - drug therapy</subject><subject>Network Meta-Analysis</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Tenecteplase</subject><subject>Tenecteplase - adverse effects</subject><subject>Thrombolytic therapy</subject><subject>Tissue plasminogen activator</subject><subject>Tissue Plasminogen Activator - adverse effects</subject><subject>Treatment Outcome</subject><issn>0022-510X</issn><issn>1878-5883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UU2P0zAQtRCILQs_gAvykUvK2E5sL5xWFV_SSlxA4mZNnIlwN4mL7e6q_BZ-LC7tcuQ0M3of0pvH2EsBawFCv9mut0teS5ByLSR0yjxiK2GNbTpr1WO2goo0nYDvF-xZzlsA0NZePWUXSmsFFtSK_d7EeYcJS7gjTuMYPPoDx2XgGUcqBx5HXmghX2g3Yaa_EE4PV1g4-n2pS_Y_aA6e55LiLb3l13yHId2Hs2Shch_TLZ-pYIMLTocc8tE8VTTO4RcN3MeliqepriUFnPJz9mSsg16c5yX79uH9182n5ubLx8-b65vGqytdmh76FjUoL6EflFQ1XWv6zowSDYzGt0q32ljd04AtgVSdGfpWCTCohK2CS_b65LtL8eeecnFzzUPThAvFfXbS6A6MkFZXqjhRfYo5JxrdLoUZ08EJcMdS3NbVUtyxFHcqpWpene33_UzDP8VDC5Xw7kSgGvIuUHLZB1o8DSHVz7shhv_Y_wH5xJ9E</recordid><startdate>20230215</startdate><enddate>20230215</enddate><creator>Rehman, Aqeeb Ur</creator><creator>Mohsin, Aleenah</creator><creator>Cheema, Huzaifa Ahmad</creator><creator>Zahid, Afra</creator><creator>Rehman, Muhammad Ebaad Ur</creator><creator>Ameer, Muhammad Zain</creator><creator>Ayyan, Muhammad</creator><creator>Ehsan, Muhammad</creator><creator>Shahid, Abia</creator><creator>Aemaz Ur Rehman, Muhammad</creator><creator>Shah, Jaffer</creator><creator>Khawaja, Ayaz</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20230215</creationdate><title>Comparative efficacy and safety of tenecteplase and alteplase in acute ischemic stroke: A pairwise and network meta-analysis of randomized controlled trials</title><author>Rehman, Aqeeb Ur ; Mohsin, Aleenah ; Cheema, Huzaifa Ahmad ; Zahid, Afra ; Rehman, Muhammad Ebaad Ur ; Ameer, Muhammad Zain ; Ayyan, Muhammad ; Ehsan, Muhammad ; Shahid, Abia ; Aemaz Ur Rehman, Muhammad ; Shah, Jaffer ; Khawaja, Ayaz</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c396t-b0b4a603c20bd32336647b57f2a70f7c43646786beda4e02357db43107a318323</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Alteplase</topic><topic>Cerebral Hemorrhage - drug therapy</topic><topic>Fibrinolytic Agents - adverse effects</topic><topic>Humans</topic><topic>Ischemic stroke</topic><topic>Ischemic Stroke - drug therapy</topic><topic>Network Meta-Analysis</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Tenecteplase</topic><topic>Tenecteplase - adverse effects</topic><topic>Thrombolytic therapy</topic><topic>Tissue plasminogen activator</topic><topic>Tissue Plasminogen Activator - adverse effects</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rehman, Aqeeb Ur</creatorcontrib><creatorcontrib>Mohsin, Aleenah</creatorcontrib><creatorcontrib>Cheema, Huzaifa Ahmad</creatorcontrib><creatorcontrib>Zahid, Afra</creatorcontrib><creatorcontrib>Rehman, Muhammad Ebaad Ur</creatorcontrib><creatorcontrib>Ameer, Muhammad Zain</creatorcontrib><creatorcontrib>Ayyan, Muhammad</creatorcontrib><creatorcontrib>Ehsan, Muhammad</creatorcontrib><creatorcontrib>Shahid, Abia</creatorcontrib><creatorcontrib>Aemaz Ur Rehman, Muhammad</creatorcontrib><creatorcontrib>Shah, Jaffer</creatorcontrib><creatorcontrib>Khawaja, Ayaz</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the neurological sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rehman, Aqeeb Ur</au><au>Mohsin, Aleenah</au><au>Cheema, Huzaifa Ahmad</au><au>Zahid, Afra</au><au>Rehman, Muhammad Ebaad Ur</au><au>Ameer, Muhammad Zain</au><au>Ayyan, Muhammad</au><au>Ehsan, Muhammad</au><au>Shahid, Abia</au><au>Aemaz Ur Rehman, Muhammad</au><au>Shah, Jaffer</au><au>Khawaja, Ayaz</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparative efficacy and safety of tenecteplase and alteplase in acute ischemic stroke: A pairwise and network meta-analysis of randomized controlled trials</atitle><jtitle>Journal of the neurological sciences</jtitle><addtitle>J Neurol Sci</addtitle><date>2023-02-15</date><risdate>2023</risdate><volume>445</volume><spage>120537</spage><epage>120537</epage><pages>120537-120537</pages><artnum>120537</artnum><issn>0022-510X</issn><eissn>1878-5883</eissn><abstract>Studies on tenecteplase have been yielding mixed results for several important outcomes at different doses, thus hampering objective guideline recommendations in acute ischemic stroke management. This meta-analysis stratifies doses in order to refine our interpretation of outcomes and quantify the benefits and harms of tenecteplase at different doses.
PubMed/MEDLINE, the Cochrane Library, and reference lists of the included articles were systematically searched. Several efficacy and safety outcomes were pooled and reported as risk ratios (RRs) with 95% confidence intervals (CIs). Network meta-analysis was used to find the optimal dose of tenecteplase. Meta-regression was run to investigate the impact of baseline NIHSS scores on functional outcomes and mortality.
Ten randomized controlled trials with a total of 4140 patients were included. 2166 (52.32%) patients were enrolled in the tenecteplase group and 1974 (47.68%) in the alteplase group. Tenecteplase at 0.25 mg/kg dose demonstrated significant improvement in excellent functional outcome at 3 months (RR 1.14, 95% CI 1.04–1.26), and early neurological improvement (RR 1.53, 95% CI 1.03–2.26). There was no statistically significant difference between tenecteplase and alteplase in terms of good functional outcome, intracerebral hemorrhage (ICH), symptomatic intracerebral hemorrhage (sICH), and 90-day mortality at any dose. Meta-regression demonstrated superior tenecteplase efficacy with increasing stroke severity, however, the results were statistically nonsignificant.
Tenecteplase at 0.25 mg/kg dose is more efficacious and at least as safe as alteplase for stroke thrombolysis. Newer analyses need to focus on direct comparison of tenecteplase doses and whether tenecteplase is efficacious at longer needle times.
•We assessed the comparative efficacy and safety of tenecteplase and alteplase.•We included 10 randomized controlled trials (RCTs) with 4140 participants.•Tenecteplase at 0.25 mg/kg dose is more efficacious and equally safe as alteplase.•Future RCTs should focus on direct comparison of tenecteplase dosages.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>36630803</pmid><doi>10.1016/j.jns.2022.120537</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Alteplase Cerebral Hemorrhage - drug therapy Fibrinolytic Agents - adverse effects Humans Ischemic stroke Ischemic Stroke - drug therapy Network Meta-Analysis Randomized Controlled Trials as Topic Tenecteplase Tenecteplase - adverse effects Thrombolytic therapy Tissue plasminogen activator Tissue Plasminogen Activator - adverse effects Treatment Outcome |
| title | Comparative efficacy and safety of tenecteplase and alteplase in acute ischemic stroke: A pairwise and network meta-analysis of randomized controlled trials |
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