Cerebrolysin for functional recovery in patients with acute ischemic stroke: a meta-analysis of randomized controlled trials

Abstract

Cerebrolysin has been shown to have an inconsistent efficacy on functional recovery in patients with acute ischemic stroke (AIS). The present meta-analysis aims to evaluate the value of cerebrolysin and to explore the potential influencing factors. The main electronic databases, including MEDLINE, EMBASE, and the Cochrane Library, were searched. The primary outcome was functional recovery at Day 90. The secondary outcomes included mortality and adverse events. A total of 1,649 patients with AIS were pooled from six randomized controlled trials (RCTs). Cerebrolysin had no significant effect on functional recovery at Day 90 compared with the effect of placebo as shown by the modified Rankin Scale response (relative risk [RR] 1.33, 95% confidence interval [CI] 0.79–2.24, P=0.28), National Institutes of Health Stroke Scale response (RR 1.03, 95% CI 0.83–1.28, P=0.77), and Barthel Index response (RR 0.95, 95% CI 0.84–1.08, P=0.44). In safety analysis, cerebrolysin did not increase the risk of adverse events (RR 0.98, 95% CI 0.88–1.09, P=0.67), risk of serious adverse events (RR 1.20, 95% CI 0.86–1.66, P=0.29), or the mortality rate (RR 0.86, 95% CI 0.57–1.31, P=0.49). In conclusion, routine administration of cerebrolysin to patients with AIS cannot be supported by the available evidence from RCTs.

Safety and efficacy of Cerebrolysin in early post-stroke recovery: a meta-analysis of nine randomized clinical trials

“…Another recent meta-analysis resulting in “no significant efficacy on the neurological functional recovery” was based on dichotomization of mRS, NIHSS, and BI at day 90, i.e., not on full outcome scales [ 36 ]. As highlighted by leading researchers and methodologists, dichotomization of a full scale is burdened with loss of power and arbitrary choice of cutoffs [ 22 , 37 , 38 ], allowing only limited statements on treatment effects.…”

Anti-inflammatory effects of neurotrophic therapy (a pilot study)

“…Показана клиническая эффективность препарата церебролизин (Ц) в комплексной терапии неврологических [18,19] и нейродегенеративных заболеваний, включая БА и MCI [20][21][22]. Ц содержит аминокислоты (85%) и пептиды (15%) нейротрофинов, энкефалинов, орексина, галанина, нейротрансмиттеров.…”

Randomized, placebo-controlled, double-blind, pilot trial to investigate safety and efficacy of Cerebrolysin in patients with aneurysmal subarachnoid hemorrhage

“…To date five meta-analyses of RCTs investigating the efficacy of Cerebrolysin in acute ischemic stroke have been performed [ 38 – 42 ]. Three, evaluating aggregate data from up to seven trials involving 1501 to 1779 patients, concluded that the medication did not demonstrate any clinical benefit [ 38 , 41 , 42 ]. In particular, a Cochrane Review did not find Cerebrolysin to be useful, but several trials were excluded from the analysis since treatment initiation exceeded the review protocol’s prespecified 48-h stroke-onset window [ 38 ].…”