Pharmacoeconomic analysis of the neuroprotective medicines in the treatment of ischemic stroke

Yagudina, R.; Kulikov, A.Yu.; Krylov, Vadim; Solovieva, Elena; Федин, А. И.

doi:10.17116/jnevro201911907160

Cited by 10 publications

(4 citation statements)

References 10 publications

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“…While clinicians in some regions may be unfamiliar with Actovegin, it is used in East Asia, Eastern Europe, and Central Asia. It is commonly referred to as a “neuroprotector” and has been frequently used to treat patients with ischemic stroke in Russia [ 25 , 26 ]. Pharmaceutical sales data suggest that usage is widespread, though declining, as Actovegin has frequently appeared on the top-15 drugs by sales volume, in every country of the Commonwealth of Independent States (CIS) for years 2018–2020 [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

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Actovegin in the management of patients after ischemic stroke: A systematic review

Fleur

Baizhaxynova²,

Reynen³

et al. 2022

PLoS ONE

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Background Actovegin is a hemodialysate of calf’s blood and has been used for several decades in the countries of Central Asia, East Asia, Russia and some European countries. It has been used to treat patients with various neurological conditions, vascular disorders, and ischemic stroke. Objectives To perform a systematic review to evaluate the effect of Actovegin in patients who have suffered an ischemic stroke. Methods A search of MEDLINE, PubMed, Cochrane and Embase was carried out from inception to October 10, 2021 for clinical trials and observational studies with a control group, published in English or Russian. Results Of 220 identified unique records, 84 full-text articles were screened, and 5 studies were selected that met the inclusion criteria. This included 4 observational studies with control groups and one randomized, placebo-controlled clinical trial. These studies enrolled a total of 3879 patients of which 720 patients received Actovegin administered intravenously and/or orally for a duration ranging from 10 to 180 days. Because of study heterogeneity, meta-analysis was not performed. No consistent evidence on improved survival, quality of life, neurologic symptoms, activities of daily living or disability was identified. One study showed statistically significant improvements in the Alzheimer’s Disease Assessment Scale, cognitive subscale, extended version (ADAS-cog+) for Actovegin compared with placebo at 6 months but the clinical relevance of this change is uncertain. One study reported a higher incidence of recurrent ischemic stroke, transient ischemic attack or intracerebral hemorrhage in patients taking Actovegin compared to placebo. Conclusions The benefits of Actovegin are uncertain and that there is potential risk of harm in patients with stroke. More evidence is needed from rigorously designed clinical trials to justify the role of Actovegin in patients with ischemic stroke.

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Section: Discussionmentioning

confidence: 99%

“…One month supply of Actovegin represents approximately 4.4% ($25) of the average income. A consideration and area for future research is to incorporate the uncertainties from the clinical data into pharmacoeconomic analyses [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Actovegin in the management of patients after ischemic stroke: A systematic review

Fleur

Baizhaxynova²,

Reynen³

et al. 2022

PLoS ONE

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“…Устраняет нарушения чувствительности и расстройства психики. Исходя из множества разнообразных положительных эффектов, препарат допустимо использовать при различных патологических состояниях [26][27][28].…”

Section: отечественные антиоксиданты: фармакотерапевтические возможности в клинической практикеunclassified

The role of oxidative stress in the pathogenesis of socially significant human diseases and ways of its drug correction

Olefir¹,

Романов²,

Кукес³

et al. 2021

Medical news of the North Caucasus

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средств медицинского применения, москва, Российская Федерация 2 Российская медицинская академия непрерывного профессионального образования, москва, Российская Федерация 3 Научно-исследовательский институт биомедицинской химии им. В. Н. Ореховича, москва, Российская Федерация 4 Научно-исследовательский институт вакцин и сывороток им. И. И. мечникова, москва, Российская Федерация

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“…These data indicate an increased need of the brain for succinate in hypoxia. Clinical studies have shown a positive effect of drugs containing succinates on the course of stroke [6][7][8][9][10][11]. In ischemic stroke, the blood-brain barrier is disrupted, which is regulated by mitochondria, immune cells, cytokines, and adhesion proteins [12].…”

Section: Introductionmentioning

confidence: 99%

Mitochondrial Disorders in Stroke and Chronic Brain Ischemia

Котов¹,

Сидорова²,

Borodataya³

et al. 2021

AJPN

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Stroke is the leading cause of disability and death in the adult population. Modern methods of treating patients with acute ischemic stroke include thrombolytic therapy with a narrow therapeutic window and endovascular thrombectomy. The development of other methods of treatment of brain hypoxia in the penumbra zone is relevant. Mitochondria, which are involved in immediate and delayed molecular mechanisms of adaptation to hypoxic stress in the cerebral cortex, primarily respond to hypoxia. Hypoxia induces reprogramming of the mitochondrial respiratory chain function and switching from oxidation of substrates of the respiratory chain complex I to succinate oxidation (complex II). The brain's need for succinate increases. Clinical studies have shown a positive effect of drugs containing succinates on the course of stroke. The study of mitochondrial function is carried out mainly in an experiment. In the present study of mitochondrial disorders in stroke and chronic brain ischemia in adult patients, the quantitative method proposed by A. G. Pearse was used to assess the activity of mitochondrial enzymes of peripheral blood lymphocytes, which are referred to as the "enematic mirror" of tissues. In acute cerebral ischemia, a compensatory increase in the activity of succinate dehydrogenase was observed on the first day, indicating the tension (increased activity) of the second complex of the mitochondrial respiratory chain.. These data confirm the need to prescribe succinic acid in the acute phase of stroke. At the same time, the dose of 250 mg per day is not sufficient for patients with increased body weight. The standard dose of the drug should be higher, taking into account the different body weight of patients. In patients with stroke, there was also a decrease in the activity of α-glycerophosphate dehydrogenase, which is involved in the fat metabolism of mitochondria, which is an indication for the appointment of carnitine. In chronic brain ischemia, the activity of succinate dehydrogenase and α-glycerophosphate dehydrogenase decreased, indicating indications for the appointment of idebenone and carnitine along with vasodilator therapy and endovascular thrombectomy. Thus, the results of a study of mitochondrial function in patients with acute and chronic brain ischemia are presented. Violations of complex II in the respiratory chain cycle and violation of fat metabolism were revealed, indicating indications for the appointment of energotropic therapy.

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Pharmacoeconomic analysis of the neuroprotective medicines in the treatment of ischemic stroke

Cited by 10 publications

References 10 publications

Actovegin in the management of patients after ischemic stroke: A systematic review

Actovegin in the management of patients after ischemic stroke: A systematic review

The role of oxidative stress in the pathogenesis of socially significant human diseases and ways of its drug correction

Mitochondrial Disorders in Stroke and Chronic Brain Ischemia

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