Department of Pharmacy Practice, Texas A&M Rangel College of Pharmacy, College Station, TX.
Department of Pharmacy Services, Indiana University Health, Indianapolis, IN.
Clin Neuropharmacol. 2022;45(1):1-6. doi: 10.1097/WNF.0000000000000487.
Traumatic brain injury (TBI) is a major cause of death and disability worldwide. Many patients who experience severe TBI have persistent disorders of consciousness. Amantadine and modafinil are used for some neurological disorders; however, a comparison of the 2 medications in TBI has not been reported. This study compared the effectiveness of amantadine, modafinil, and standard of care (SOC) on disorders of consciousness after TBI.
All adult TBI patients admitted between January 1, 2017, and September 31, 2020 who received amantadine, modafinil, or SOC treatments were screened. Data collection included: demographics, change in Glasgow Coma Scale (GCS), location of hemorrhage, medication duration, intensive care unit and hospital length of stay, adverse drug reactions, and concomitant sedative medications. Patients in the amantadine and modafinil groups were matched 1:2 with patients who received SOC therapies. The primary outcome was change in GCS ≥ 3 from baseline to discharge.
A total of 142 patients met inclusion criteria. Medications were initiated a median of 8 days from admission. Patients in the SOC group experienced a greater improvement in GCS and shorter hospital length of stay compared with amantadine. A change in GCS ≥ 3 from medication initiation to hospital discharge occurred in 46.5% of amantadine patients and 53.8% of modafinil patients.
In this study, TBI patients did not benefit from amantadine or modafinil compared with SOC therapies, and no differences were found between medication groups. Further studies are warranted to determine whether the addition of amantadine or modafinil in the weeks after TBI provides benefit.
创伤性脑损伤（TBI）是全球范围内导致死亡和残疾的主要原因。许多经历严重 TBI 的患者都存在持续性意识障碍。金刚烷胺和莫达非尼用于治疗一些神经疾病；然而，尚未有报道比较这 2 种药物在 TBI 中的作用。本研究比较了金刚烷胺、莫达非尼和 TBI 标准治疗（SOC）对意识障碍的疗效。
筛选了 2017 年 1 月 1 日至 2020 年 9 月 31 日期间入院的所有成年 TBI 患者，这些患者接受了金刚烷胺、莫达非尼或 SOC 治疗。数据收集包括：人口统计学特征、格拉斯哥昏迷量表（GCS）变化、出血部位、药物治疗持续时间、重症监护病房和医院住院时间、药物不良反应和同时使用的镇静药物。将金刚烷胺和莫达非尼组的患者与接受 SOC 治疗的患者按照 1:2 进行匹配。主要结局是从入院到出院时 GCS 增加≥3 分。
共有 142 名患者符合纳入标准。药物治疗在入院后中位数 8 天开始。与金刚烷胺相比，SOC 组患者的 GCS 改善更明显，住院时间更短。从开始用药到出院时 GCS 增加≥3 分的患者在金刚烷胺组中占 46.5%，在莫达非尼组中占 53.8%。
在这项研究中，与 SOC 治疗相比，TBI 患者并未从金刚烷胺或莫达非尼中获益，且药物组之间未发现差异。需要进一步的研究来确定在 TBI 后数周内添加金刚烷胺或莫达非尼是否有益。
