Qin Mingzhen, Feng Luda, Yang Chinyu, Wei Dawei, Li Tingting, Jiang Ping, Guan Jinzhi, Zhang Xinyue, Shi Xinyi, Liang Ning, Lai Xinxing, Zhou Li, Zhang Chi, Gao Ying
Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China.
Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
Front Pharmacol. 2022 Aug 12;13:935198. doi: 10.3389/fphar.2022.935198. eCollection 2022.
Edaravone alleviates neurological deficits among patients with intracerebral hemorrhage; however, its effects on mortality and long-term functional outcomes remain unknown. To assess clinical outcomes associated with edaravone initiated within 7 days of symptoms onset in intracerebral hemorrhage. We systematically searched PubMed, Embase, Cochrane Library, CiNii, China National Knowledge Infrastructure, Chinese VIP information, Wanfang Data, and SinoMed for relevant randomized controlled trials from their inception to 1 May 2021 and conducted a comprehensive systematic review and meta-analysis (PROSPERO registration number: CRD42019147801). All-cause mortality and long-term functional outcomes were taken as the primary outcomes. A total of 38 randomized controlled trials including 3,454 participants with acute intracerebral hemorrhage were included. The selected articles were of poor quality. Meta-analysis revealed that edaravone could not reduce all-cause mortality [relative risk (RR) = 0.51; 95% confidence interval (CI) (0.11-2.32); = 0.38]. No studies reported on long-term functional outcomes in those trials. In addition, edaravone alleviated neurological deficits [mean difference (MD) = -5.44; 95% CI (-6.44 to -4.44); <0.00001], improved the activities of daily living [MD = 8.44; 95% CI (7.65-9.23); <0.00001], reduced the hematoma volume [MD = -4.71; 95% CI (-5.86 to -3.56); <0.00001], and increased treatment response [RR = 1.26; 95% CI (1.22-1.31); <0.00001]. In terms of safety outcome, there was no significant difference between the edaravone group and the control groups [RR = 1.67; 95% CI (0.92 to 3.06); = 0.09]. Till date, edaravone does not associate with mortality reduction when initiated within 7 days of intracerebral hemorrhage onset. The effect of edaravone on long-term functional outcomes remains unknown due to lack of data. Although edaravone alleviated neurological deficits, improved activities of daily living, and reduced hematoma volume, we cautiously interpreted the results owing to the overall poor quality and high heterogeneity of the included trials. Presently, the results are insufficient to support edaravone as a routine treatment option for acute intracerebral hemorrhage.
依达拉奉可减轻脑出血患者的神经功能缺损；然而，其对死亡率和长期功能结局的影响尚不清楚。为了评估脑出血症状发作7天内开始使用依达拉奉的临床结局。我们系统检索了PubMed、Embase、Cochrane图书馆、CiNii、中国知网、中文维普资讯、万方数据和中国生物医学文献数据库，以查找从建库至2021年5月1日的相关随机对照试验，并进行了全面的系统评价和荟萃分析（国际前瞻性系统评价注册编号：CRD42019147801）。全因死亡率和长期功能结局被作为主要结局。共纳入38项随机对照试验，包括3454例急性脑出血患者。所选文章质量较差。荟萃分析显示，依达拉奉不能降低全因死亡率[相对危险度（RR）=0.51；95%置信区间（CI）（0.11 - 2.32）；P = 0.38]。这些试验中没有关于长期功能结局的报道。此外，依达拉奉减轻了神经功能缺损[平均差（MD）=-5.44；95%CI（-6.44至-4.44）；P<0.00001]，改善了日常生活活动能力[MD = 8.44；95%CI（7.65 - 9.23）；P<0.00001]，减少了血肿体积[MD = -4.71；95%CI（-5.86至-3.56）；P<0.00001]，并提高了治疗反应率[RR = 1.26；95%CI（1.22 - 1.31）；P<0.00001]。在安全性结局方面，依达拉奉组与对照组之间无显著差异[RR = 1.67；95%CI（0.92至3.06）；P = 0.09]。迄今为止，脑出血发作7天内开始使用依达拉奉与降低死亡率无关。由于缺乏数据，依达拉奉对长期功能结局的影响尚不清楚。尽管依达拉奉减轻了神经功能缺损，改善了日常生活活动能力，并减少了血肿体积，但由于纳入试验的总体质量较差且异质性较高，我们对结果进行了谨慎解读。目前，这些结果不足以支持依达拉奉作为急性脑出血的常规治疗选择。
