Tenecteplase vs. alteplase for the treatment of patients with acute ischemic stroke: a systematic review and meta-analysis

Ma, Pengju; Zhang, Yi; Chang, Li; Li, Xiangsheng; Diao, Yuling; Chang, Haigang; Liu, Hui

doi:10.1007/s00415-022-11242-4

Cited by 24 publications

(26 citation statements)

References 49 publications

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“…Over the last few years, numerous studies have compared TNK with TPA in AIS. Mounting evidence exists that TNK is non-inferior to TPA in AIS, with some studies even suggesting that TNK might result in more favorable outcomes 8–15. The EXTEND-IA TNK randomized controlled trial (RCT) was a landmark study, published in 2018, on the usefulness of TNK in LVO AIS.…”

Section: Introductionmentioning

confidence: 99%

Tenecteplase versus alteplase before mechanical thrombectomy: experience from a US healthcare system undergoing a system-wide transition of primary thrombolytic

Hendrix

Collins

Griessenauer

et al. 2022

J NeuroIntervent Surg

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BackgroundTenecteplase (TNK) is a genetically modified variant of alteplase (TPA) and has been established as a non-inferior alternative to TPA in acute ischemic stroke (AIS). Whether TNK exerts distinct benefits in large vessel occlusion (LVO) AIS is still being investigated.ObjectiveTo describe our first-year experience after a healthcare system-wide transition from TPA to TNK as the primary thrombolytic.MethodsPatients with AIS who received intravenous thrombolytics between January 2020 and August 2022 were retrospectively reviewed. All patients with LVO considered for mechanical thrombectomy (MT) were included in this analysis. Spontaneous recanalization (SR) after TNK/TPA was a composite variable of reperfusion >50% of the target vessel territory on cerebral angiography or rapid, significant neurological recovery averting MT. Propensity score matching (PSM) was performed to compare SR rates between TNK and TPA.ResultsA total of 148 patients were identified; 51/148 (34.5%) received TNK and 97/148 (65.5%) TPA. The middle cerebral arteries M1 (60.8%) and M2 (29.7%) were the most frequent occlusion sites. Baseline demographics were comparable between TNK and TPA groups. Spontaneous recanalization was significantly more frequently observed in the TNK than in the TPA groups (unmatched: 23.5% vs 10.3%, P=0.032). PSM substantiated the observed SR rates (20% vs 10%). Symptomatic intracranial hemorrhage, 90-day mortality, and functional outcomes were similar.ConclusionsThe preliminary experience from a real-world setting demonstrates the effectiveness and safety of TNK before MT. The higher spontaneous recanalization rates with TNK are striking. Additional studies are required to investigate whether TNK is superior to TPA in LVO AIS.

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Section: Introductionmentioning

confidence: 99%

Tenecteplase versus alteplase before mechanical thrombectomy: experience from a US healthcare system undergoing a system-wide transition of primary thrombolytic

Hendrix

Collins

Griessenauer

et al. 2022

J NeuroIntervent Surg

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“…The incremental cost-effectiveness ratio of the Melbourne MSU, which the TASTE-a trial was based on, was very favourable at $30,982 per disability-adjusted life year avoided, falling below the often used willingness to pay per DALY threshold in Australia of AUD 50,000. It is probable that with the suggested greater lytic ability of tenecteplase compared to alteplase, 28,29 its administration in the pre-hospital MSU setting may improve the cost-effectiveness of the MSU, mainly due to potential further downstream healthcare cost-savings. The cost of operating the Melbourne MSU was around $2.8 million per annum, including the one-off purchase and set-up cost of MSU 30 averaged over a 5 years period.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of tenecteplase versus alteplase for stroke thrombolysis evaluation trial in the ambulance

Gao

Чурилов

Zhao

et al. 2023

European Stroke Journal

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Background: Tenecteplase administered to patients with ischaemic stroke in a mobile stroke unit (MSU) has been shown to reduce the perfusion lesion volumes and result in ultra-early recovery. We now seek to assess the cost-effectiveness of tenecteplase in the MSU. Methods: A within-trial (TASTE-A) economic analysis and a model-based long-term cost-effectiveness analysis were performed. This post hoc within-trial economic analysis utilised the patient-level data (intention to treat, ITT) prospectively collected over the trial to calculate the difference in both healthcare costs and quality-adjusted life years (QALYs, estimated from modified Rankin scale score). A Markov microsimulation model was developed to simulate the long-term costs and benefits. Results: In total, there were 104 patients with ischaemic stroke randomised to tenecteplase ( n = 55) or alteplase ( n = 49) treatment groups, respectively in the TASTE-A trial. The ITT-based analysis showed that treatment with tenecteplase was associated with non-signficantly lower costs (A$28,903 vs A$40,150 ( p = 0.056)) and greater benefits (0.171 vs 0.158 ( p = 0.457)) than that for the alteplase group over the first 90 days post the index stroke. The long-term model showed that tenecteplase led to greater savings in costs (−A$18,610) and more health benefits (0.47 QALY or 0.31 LY gains). Tenecteplase-treated patients had reduced costs for rehospitalisation (−A$1464), nursing home care (−A$16,767) and nonmedical care (−A$620) per patient. Conclusions: Treatment of ischaemic stroke patients with tenecteplase appeared to be cost-effective and improve QALYs in the MSU setting based on Phase II data. The reduced total cost from tenecteplase was driven by savings from acute hospitalisation and reduce need for nursing home care.

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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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Tenecteplase vs. alteplase for the treatment of patients with acute ischemic stroke: a systematic review and meta-analysis

Cited by 24 publications

References 49 publications

Tenecteplase versus alteplase before mechanical thrombectomy: experience from a US healthcare system undergoing a system-wide transition of primary thrombolytic

Tenecteplase versus alteplase before mechanical thrombectomy: experience from a US healthcare system undergoing a system-wide transition of primary thrombolytic

Cost-effectiveness of tenecteplase versus alteplase for stroke thrombolysis evaluation trial in the ambulance

Intravenous Thrombolysis for Acute Ischemic Stroke

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