Citicoline for Acute Ischemic Stroke: A Systematic Review and Formal Meta-analysis of Randomized, Double-Blind, and Placebo-Controlled Trials
Autor: | José Castillo, Exuperio Díez-Tejedor, Julio J. Secades, José Ríos, Natalia Oudovenko, José Alvarez-Sabín, Eduardo Martínez-Vila |
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Rok vydání: | 2016 |
Předmět: |
Male
Cytidine Diphosphate Choline Placebo law.invention Brain Ischemia 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Double-Blind Method law Medicine Humans 030212 general & internal medicine Acute ischemic stroke Nootropic Agents Randomized Controlled Trials as Topic business.industry Rehabilitation Odds ratio Confidence interval Clinical trial Stroke Anesthesia Meta-analysis Surgery Female Neurology (clinical) Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery Citicoline medicine.drug |
Zdroj: | Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 25(8) |
ISSN: | 1532-8511 |
Popis: | Background Citicoline is a drug approved for the treatment of acute ischemic stroke. Although evidence of its efficacy has been reported, recently published results of a large placebo-controlled clinical trial did not show differences. This study aims to assess whether starting citicoline treatment within 14 days after stroke onset improves the outcome in patients with acute ischemic stroke, as compared with placebo. Methods A systematic search was performed to identify all published, unconfounded, randomized, double-blind, and placebo-controlled clinical trials of citicoline in acute ischemic stroke. Results Ten randomized clinical trials met our inclusion criteria. The administration of citicoline was associated with a significant higher rate of independence, independently of the method of evaluation used (odds ratio [OR] 1.56, 95% confidence interval [CI] = 1.12-2.16 under random effects; OR 1.20, 95% CI = 1.06-1.36 under fixed effects). After studying the cumulative meta-analysis, and with the results obtained with the subgroup of patients who were not treated with recombinant tissue plasminogen activator (rtPA) (OR 1.63, 95% CI = 1.18-2.24 under random effects; OR 1.42, 95% CI = 1.22-1.66 under fixed effects), our hypothesis of dilution of the effect of citicoline was confirmed. When we analyzed the effect of citicoline in patients who were not treated with rtPA and were receiving the highest dose of citicoline started in the first 24 hours after onset, based on more recent trials, there was no heterogeneity, and the size of the effect has an OR of 1.27 (95% CI = 1.05-1.53). Conclusions This systematic review supports some benefits of citicoline in the treatment of acute ischemic stroke. But, on top of the best treatment available (rtPA), citicoline offers a limited benefit. |
Databáze: | OpenAIRE |
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