Secades Julio José, Trimmel Helmut, Salazar Byron, González José Antonio
Medical Department, Ferrer, 08029 Barcelona, Spain.
Department of Anaesthesiology, Emergency Medicine and Critical Care, General Hospital of Wiener Neustadt, 2700 Wiener Neustadt, Austria.
Life (Basel). 2023 Jan 29;13(2):369. doi: 10.3390/life13020369.
Citicoline or CDP-choline is a neuroprotective/neurorestorative drug used in several countries for the treatment of traumatic brain injury (TBI). Since the publication of the controversial COBRIT, the use of citicoline has been questioned in this indication, so it was considered necessary to undertake a systematic review and meta-analysis to evaluate whether citicoline is effective in the treatment of patients with TBI.
A systematic search was performed on OVID-Medline, EMBASE, Google Scholar, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and Ferrer databases, from inception to January 2021, to identify all published, unconfounded, comparative clinical trials of citicoline in the acute phase of head-injured patients- that is, treatment started during the first 24 h. We selected studies on complicated mild, moderate, and severe head-injured patients according to the score of the Glasgow Coma Scale (GCS). The primary efficacy measure was independence at the end of the scheduled clinical trial follow-up.
In total, 11 clinical studies enrolling 2771 patients were identified by the end. Under the random-effects model, treatment with citicoline was associated with a significantly higher rate of independence (RR, 1.18; 95% CI = 1.05-1.33; I2, 42.6%). The dose of citicoline or the administration route had no effect on outcomes. Additionally, no significant effects on mortality were found, and no safety concerns were noticed.
This meta-analysis indicates some beneficial effects of citicoline's increasing the number of independent patients with TBI. The most important limitation of our meta-analysis was the presumed heterogeneity of the studies included.
PROSPERO CRD42021238998.
胞磷胆碱是一种神经保护/神经恢复药物，在多个国家用于治疗创伤性脑损伤（TBI）。自颇具争议的COBRIT研究发表以来，胞磷胆碱在该适应症中的使用受到质疑，因此有必要进行系统评价和荟萃分析，以评估胞磷胆碱治疗TBI患者是否有效。
对OVID-Medline、EMBASE、谷歌学术、Cochrane对照试验中央注册库、ClinicalTrials.gov和Ferrer数据库进行系统检索，检索时间从建库至2021年1月，以确定所有已发表的、无混杂因素的、关于胞磷胆碱在颅脑损伤患者急性期（即在最初24小时内开始治疗）的比较临床试验。我们根据格拉斯哥昏迷量表（GCS）评分选择了关于复杂型轻度、中度和重度颅脑损伤患者的研究。主要疗效指标是在预定的临床试验随访结束时达到独立状态。
最终共确定了11项纳入2771例患者的临床研究。在随机效应模型下，胞磷胆碱治疗组的独立率显著更高（RR，1.18；95%CI = 1.05-1.33；I²，42.6%）。胞磷胆碱的剂量或给药途径对结果无影响。此外，未发现对死亡率有显著影响，也未发现安全问题。
这项荟萃分析表明，胞磷胆碱对增加TBI独立患者数量有一些有益作用。我们荟萃分析最重要的局限性是所纳入研究可能存在异质性。
PROSPERO CRD42021238998
