Comparative efficacy and safety among different doses of tenecteplase for acute ischemic stroke: a systematic review and network meta-analysis
Issued Date
2024-08-01
Resource Type
ISSN
10523057
eISSN
15328511
Scopus ID
2-s2.0-85196272336
Journal Title
Journal of Stroke and Cerebrovascular Diseases
Volume
33
Issue
8
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Stroke and Cerebrovascular Diseases Vol.33 No.8 (2024)
Suggested Citation
Srisurapanont K., Uawithya E., Dhanasomboon P., Pollasen N., Thiankhaw K. Comparative efficacy and safety among different doses of tenecteplase for acute ischemic stroke: a systematic review and network meta-analysis. Journal of Stroke and Cerebrovascular Diseases Vol.33 No.8 (2024). doi:10.1016/j.jstrokecerebrovasdis.2024.107822 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/98992
Title
Comparative efficacy and safety among different doses of tenecteplase for acute ischemic stroke: a systematic review and network meta-analysis
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Corresponding Author(s)
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Abstract
Objectives: Tenecteplase (TNK) is a promising alternative to alteplase (ALT) as the thrombolytic agent for acute ischemic stroke (AIS). However, its clinical outcomes in certain populations remain unclear. This study aimed to compare the efficacy and safety among different doses of TNK in AIS patients. Methods: We searched PubMed, Scopus, Cochrane Central Register of Controlled Trials, and Embase for studies comparing at least one dose of TNK to another dose of TNK or ALT 0.90 mg/kg. We conducted Bayesian network meta-analyses to estimate the relative risks (RRs) and 95% credible intervals (CrIs) for all outcomes using ALT 0.90 mg/kg as the reference. The treatments were ranked according to their surface under the cumulative ranking (SUCRA) values. Results: We included 11 trials from 16 publications comprising 5,423 participants. There were no significant differences between any doses of TNK and ALT for reperfusion, 3-month modified Rankin Score (mRS) 0-1 (rank 1st: TNK 0.25 mg/kg; SUCRA = 0.68), mRS 0-2 (rank 1st: TNK 0.25 mg/kg; SUCRA = 0.86), mortality (rank 1st: TNK 0.25 mg/kg; SUCRA = 0.82), intracranial hemorrhage (ICH) (rank 1st: TNK 0.25 mg/kg; SUCRA = 0.88), symptomatic ICH (sICH) (rank 1st: TNK 0.10 mg/kg; SUCRA = 0.70), and parenchymal hematoma (rank 1st: TNK 0.10 mg/kg; SUCRA = 0.68). TNK 0.40 mg/kg had a significantly higher sICH rate compared to TNK 0.25 mg/kg (RR = 2.39, 95% CrI = 1.00-7.92). Among elderly patients, TNK 0.25 mg/kg had a significantly lower rate of sICH than ALT 0.9 mg/kg (RR = 3.0 × 10-13, 95% CrI = 3.4 × 10-40-0.07). Conclusions: TNK has efficacy and safety outcomes comparable to those of ALT. TNK 0.25 mg/kg may be the optimal dose of TNK for patients with AIS.