A systematic-search-and-review of registered pharmacological therapies investigated to improve neuro-recovery after a stroke

Abstract

BackgroundStroke burden is largely due to long-term impairments requiring prolonged care with loss of productivity. We aimed to identify and assess studies of different registered pharmacological therapies as treatments to improve post-stroke impairments and/or disabilities.MethodsWe performed a systematic-search-and-review of treatments that have been investigated as recovery-enhancing or recovery-promoting therapies in adult patients with stroke. The treatment must have received registration or market authorization in any country regardless of primary indication. Outcomes included in the review were neurological impairments and functional/disability assessments. “The best available studies” based on study design, study size, and/or date of publication were selected and graded for level of evidence (LOE) by consensus.ResultsOur systematic search yielded 7,801 citations, and we reviewed 665 full-text papers. Fifty-eight publications were selected as “the best studies” across 25 pharmacological classes: 31 on ischemic stroke, 21 on ischemic or hemorrhagic stroke, 4 on intracerebral hemorrhage, and 2 on subarachnoid hemorrhage (SAH). Twenty-six were systematic reviews/meta-analyses, 29 were randomized clinical trials (RCTs), and three were cohort studies. Only nimodipine for SAH had LOE A of benefit (systematic review and network meta-analysis). Many studies, some of which showed treatment effects, were assessed as LOE C-LD, mainly due to small sample sizes or poor quality. Seven interventions had LOE B-R (systematic review/meta-analysis or RCT) of treatment effects.ConclusionOnly one commercially available treatment has LOE A for routine use in stroke. Further studies of putative neuroprotective drugs as adjunctive treatment to revascularization procedures and more confirmatory trials on recovery-promoting therapies will enhance the certainty of their benefit. The decision on their use must be guided by the clinical profile, neurological impairments, and target outcomes based on the available evidence.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=376973, PROSPERO, CRD42022376973.

Translational Medicine in Acute Ischemic Stroke and Traumatic Brain Injury—NeuroAiD Trials, from Traditional Beliefs to Evidence-Based Therapy

“…Collectively, the current efficacy data have recently allowed these formulations to be included in the recommendations of two international guidelines. For stroke, a group of experts from the Asian Stroke Advisory Panel gave them a B-R (randomized) level recommendation in 2024, defined as moderate quality evidence from one or more RCTs and meta-analyses of moderate quality [ 110 ]. For TBI, in the International Cognitive Sciences Group of Researchers and Clinicians (INCOG 2.0) guidelines, MLC901 is recommended with the highest level (A) of evidence for improving complex attention in people with mild to moderate TBI [ 111 ].…”