Short-Term Efficacy Outcomes of Tenecteplase versus Alteplase for Acute Ischemic Stroke: A Meta-Analysis of 5 Randomized Trials

Requiao, Leticia; Oliveira, Roberto S; Reis, Lorena S; Assis, Ana P B; Moreno, Beatriz N G; Cordeiro, Luisa Rodrigues; Solla, Davi F

doi:10.4103/0028-3886.355108

Cited by 3 publications

(5 citation statements)

References 20 publications

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Section: Discussionmentioning

confidence: 99%

“…Several systematic reviews and meta-analyses have compared the effectiveness and safety of TNK and alteplase for treating AIS with superior and non-inferiority designs. [33][34][35][36][37][38][39][40][41][42][43][44][45] Overall, the studies suggested that TNK may be more effective than Alteplase in improving early neurological function and higher recanalization rates; there have been no significant differences between the two drugs regarding functional outcomes, disability-free three-month outcomes, or mortality. The optimal dose of TNK appears to be 0.25 mg/kg, which has been shown to have the greatest odds of achieving early neurological improvement and an excellent functional outcome at three months, with reduced odds of ICH.…”

Section: Studymentioning

confidence: 99%

“…The optimal dose of TNK appears to be 0.25 mg/kg, which has been shown to have the greatest odds of achieving early neurological improvement and an excellent functional outcome at three months, with reduced odds of ICH. [33][34][35][36][37][38][39][40][41][42][43][44][45] A recently published randomized controlled noninferiority trial involving 1,430 participants conducted in China evaluated the efficacy and safety of TNK compared to Alteplase in adults with an AIS who were not eligible for endovascular thrombectomy. The results showed that the TNK and Alteplase were comparable in efficacy (mRS score of 0-1 at 90 days) and safety (mortality and ICH).…”

Section: Studymentioning

confidence: 99%

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Tenecteplase versus Alteplase in Acute Ischemic Stroke: A Systematic Review and Meta-analysis

Singh,

Gaikwad

et al. 2023

Annals of Neurosciences

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Background A number of clinical trials have compared tenecteplase (TNK) and alteplase for the management of acute ischemic stroke (AIS) and the results are inconsistent. Purpose Present systematic review and meta-analysis is undertaken to analyse the efficacy and safety of TNK in AIS compared to alteplase. Summary A thorough literature search was performed through the databases Embase, Cochrane Library, PubMed, and clinicaltrials.gov, for a period from inception to September 2022, with the keywords i.e., “tenecteplase” and “alteplase” and “acute ischemic stroke.” Clinical trials published in English that compared the efficacy and safety of TNK to alteplase in AIS were included. The major outcomes of this meta-analysis were proportion of patients free from disability and functional independence at 90 days, early neurological improvement at 24 hours, all-cause mortality at 90 days, patients with intra cranial hemorrhage (ICH), and patients with severe disability at 90 days. A total of nine studies with 3,573 patients were included in the analysis. The proportion of patients with freedom from disability was comparable in both groups (relative risk [RR] = 1.04, 95 per cent CI = 0.92–1.17; p = .53). Similarly, proportion of patients with functional independence was comparable (RR = 1.12, 95 per cent CI = 0.96–1.31; p = .14). TNK group had a higher rate of early neurological recovery (RR = 1.56, 95 per cent CI = 0.96–2.54; p = .07). All-cause mortality at 90 days was comparable in both groups (RR = 0.97; 95 per cent CI = 0.72–1.29; p = .82). The proportion of patients with ICH was higher in TNK group (RR = 1.14, 95 per cent CI = 0.77–1.68; p = .52). The proportion of patients with severe disability was less in TNK group (RR =0.84, 95 per cent CI = 0.53–1.32; p = .44). Key Message TNK was similar to alteplase in terms of efficacy and safety. The patients in TNK group showed early neurological improvement but were simultaneously at higher risk of ICH. The TNK can be an alternative to alteplase if the benefits outweigh the risks.

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Section: Discussionmentioning

confidence: 99%

Section: Studymentioning

confidence: 99%

Section: Studymentioning

confidence: 99%

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Tenecteplase versus Alteplase in Acute Ischemic Stroke: A Systematic Review and Meta-analysis

Singh,

Gaikwad

et al. 2023

Annals of Neurosciences

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“…Recent studies suggest that the use of tenecteplase in strokes due to large vessel occlusions (LVO) may also be associated with fewer bleeding complications. The most robust evidence to date, based on 3 large, randomized trials [AcT (Alteplase Compared to Tenecteplase), TRACE 2 (Tenecteplase versus alteplase in acute ischaemic cerebrovascular events), and ATTEST 2 (Alteplase versus tenecteplase for thrombolysis after ischaemic stroke)] 29,30 and 3 different meta-analyses of studies, 31–33 indicates that tenecteplase is at least “noninferior” to rt-PA, implying comparable outcomes and safety profiles. The meta-analysis by Katsanos et al 33 , which analyzed data from 443 patients drawn from 4 trials, suggested that tenecteplase may be superior to alteplase for recanalization and noninferior for 3-month of disability outcomes.…”

Section: The Advent Of Tenecteplasementioning

confidence: 99%

Treatment of Acute Ischemic Stroke: The Last 30 Years of Trials and Tribulations

Jan,

Chong

2024

Cardiology in Review

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The landscape of acute ischemic stroke management has undergone a substantial transformation over the past 3 decades, mirroring our enhanced comprehension of the pathology and progress in diagnostic techniques, therapeutic interventions, and preventive measures. The 1990s marked a pivotal moment in stroke care with the integration of intravenous thrombolytics. However, the most significant paradigm shift in recent years has undoubtedly been the advent of endovascular thrombectomy. This article endeavors to deliver an exhaustive analysis of this revolutionary progression.

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“…Several studies of tenecteplase versus rtPA are ongoing and should provide a definitive answer about best dose and relative efficacy. However, the best evidence to date, based on two large, randomized comparisons 53,54 and three different meta-analyses of studies, 55-57 shows that tenecteplase is “noninferior” to rtPA, meaning their outcomes and safety are similar. Other thrombolytics are also under evaluation 58 …”

Section: Tenecteplase and Other Approachesmentioning

confidence: 99%

Intravenous Thrombolysis for Acute Ischemic Stroke

Grotta¹

2023

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVEThis article reviews the history of IV thrombolysis, its current indications and implementation, the duality of the “time is brain” versus “tissue clock” approaches, the impact of endovascular thrombectomy on IV thrombolysis, the emergence of tenecteplase, and future research directions.LATEST DEVELOPMENTSThe growing use of factor Xa inhibitors has increasingly caused patients with stroke to be excluded from treatment with IV thrombolysis. Important geographic, socioeconomic, sex, race, and ethnic disparities have been identified in the implementation of IV thrombolysis and need to be overcome. IV thrombolysis substantially improves outcomes when provided within the first golden hour after stroke onset in patients treated in mobile stroke units, supporting the “time is brain” concept and encouraging the possible value of more widespread implementation of the mobile stroke unit approach. At the same time, other studies have shown that IV thrombolysis can be successful in patients whose “tissue clock” is still ticking up to 9 hours after stroke onset or in patients who awaken with their stroke, as demonstrated by favorable imaging profiles. These considerations, along with the emergence of endovascular thrombectomy, have fostered examination of our care systems, including the “drip and ship” versus direct to comprehensive or endovascular thrombectomy stroke center approaches, as well as the possibility of skipping IV thrombolysis in certain patients treated with endovascular thrombectomy. Data suggesting that tenecteplase is at least noninferior to alteplase, as well as its more convenient dosing, has led to its increased use. Ongoing studies are evaluating newer thrombolytics and adding antithrombotic therapy to IV thrombolysis.ESSENTIAL POINTSIV thrombolysis remains the most common acute stroke treatment. Advances in acting faster to treat stroke have increased its efficacy, and advances in imaging have expanded its use. However, implementing these advances and overcoming disparities in IV thrombolysis use remain major challenges.

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Short-Term Efficacy Outcomes of Tenecteplase versus Alteplase for Acute Ischemic Stroke: A Meta-Analysis of 5 Randomized Trials

Cited by 3 publications

References 20 publications

Tenecteplase versus Alteplase in Acute Ischemic Stroke: A Systematic Review and Meta-analysis

Tenecteplase versus Alteplase in Acute Ischemic Stroke: A Systematic Review and Meta-analysis

Treatment of Acute Ischemic Stroke: The Last 30 Years of Trials and Tribulations

Intravenous Thrombolysis for Acute Ischemic Stroke

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