Tenecteplase vs. Alteplase for Intravenous Thrombolytic Therapy of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Introduction In recent years, as one of the drugs for the treatment of acute ischemic stroke (AIS), the clinical application of tenecteplase is still controversial. Therefore, we aimed to evaluate the safety and efficacy of tenecteplase versus alteplase to guide clinical practice. Methods A search of PubMed, MEDLINE, EMBASE, Cochrane Library, and Web of Science databases until February 15, 2023 was conducted to identify eligible articles. The quality of the included studies was assessed using the Cochrane Risk of Bias tool. RevMan 5.3 and Stata 17 were used to perform the meta-analysis and detect publication bias, and risk ratios (RRs) with 95% confidence intervals (95% CIs) were reported for each outcome measure. Results A total of 1326 records were retrieved in this meta-analysis. As a result of the limited reports on tenecteplase in patients with AIS and the lack of high-quality randomized controlled trials (RCTs), and considering the impact of publication bias, we did not include any of these studies published before 2015. Ultimately we included 16 RCTs with a total of 7508 patients, including 3940 patients treated with alteplase and 3568 patients treated with tenecteplase. Tenecteplase was associated with better early neurological improvement (RR 0.10; 95% CI 0.00–0.19; P = 0.04), recanalization of blood vessels (RR 0.24; 95% CI 0.07–0.40; P = 0.01), and 90-day excellent neurological recovery (RR 0.12; 95% CI 0.01–0.24; P = 0.04). In addition, there were no significant differences in other efficacy and safety outcomes between the two groups. The funnel plot and Begg’s as well as Egger’s tests showed no significant publication bias. Conclusions This meta-analysis showed that tenecteplase was not inferior to alteplase in early thrombolytic therapy in patients with AIS, and was even better than alteplase on some efficacy outcomes with no significant differences in safety. However, as a result of some inherent limitations of this study, more high-quality prospective clinical studies are needed to confirm these results..

Plain Language Summary In recent years, there has been controversy surrounding the use of tenecteplase, a drug for treating acute ischemic stroke (AIS). To help doctors make better decisions, we compared the safety and effectiveness of tenecteplase with another drug called alteplase. We looked at various research articles from PubMed, MEDLINE, EMBASE, Cochrane Library, and Web of Science databases until February 15, 2023. After careful analysis, we found 16 relevant studies with a total of 7508 patients, including those treated with alteplase and tenecteplase. Our findings showed that tenecteplase was as effective as alteplase in providing early thrombolytic therapy for patients with AIS. In fact, tenecteplase even showed better results in some aspects of treatment, without compromising safety. However, we acknowledge some limitations in our study and recommend more high-quality clinical studies to validate these results..

Medienart:	E-Artikel

Erscheinungsjahr:	2023
Erschienen:	2023

Enthalten in:	Zur Gesamtaufnahme - volume:12
Enthalten in:	Neurology and Therapy - 12(2023), 5 vom: 08. Aug., Seite 1553-1572

Sprache:	Englisch

Beteiligte Personen:	Shen, Ziyi [VerfasserIn] Bao, Nana [VerfasserIn] Tang, Ming [VerfasserIn] Yang, Yang [VerfasserIn] Li, Jia [VerfasserIn] Liu, Wei [VerfasserIn] Jiang, Guohui [VerfasserIn]

Links:	Volltext [kostenfrei]

Themen:	Acute ischemic stroke Alteplase Meta-analysis Systematic review Tenecteplase Thrombolytic therapy

Anmerkungen:	© The Author(s) 2023

doi:	10.1007/s40120-023-00530-4

funding:
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PPN (Katalog-ID):	OLC2145156860