Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
West China Brain Research Centre, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
Neurocrit Care. 2024 Aug;41(1):49-58. doi: 10.1007/s12028-024-01957-9. Epub 2024 Apr 2.
There are knowledge gaps regarding the relative efficacy of statins for aneurysmal subarachnoid hemorrhage (aSAH). This study aims to examine the comparative effectiveness and determine the ranking of different statins with network meta‑analysis in patients with aSAH.
MEDLINE, Embase, Pubmed, and Cochrane Central Register of Controlled Trials were searched from database inception until December 15, 2022. Outcomes included delayed cerebral ischemia (DCI), functional recovery, and mortality. Relative risk (RRs) ratios and associated 95% confidence intervals (CIs) were estimated. The values derived from surface under the cumulative ranking curve were obtained to rank the treatment hierarchy in the analysis.
We identified 13 trials involving 1,885 patients. Atorvastatin 20 mg (RR 0.68, 95% CI 0.53-0.86), pravastatin 40 mg (RR 0.51, 95% CI 0.31-0.77), and simvastatin 80 mg (RR 0.54, 95% CI 0.40-0.70) were superior to the placebo in preventing DCI. Additionally, simvastatin 80 mg (RR 0.60, 95% CI 0.42-0.84) and pravastatin 40 mg (RR 0.56, 95% CI 0.32-0.93) were associated with a decreased risk of DCI than simvastatin 40 mg. Comparisons across treatment durations suggested that short-term (RR 0.62, 95% CI 0.50-0.76) statin therapy reduced risk of DCI.
Simvastatin 80 mg might be the most effective intervention in reducing DCI. Additionally, short-term therapy might provide more benefits. Further research with longer follow-up is warranted to validate the current findings in patients with aSAH who are at high risk of DCI.
关于他汀类药物治疗颅内动脉瘤性蛛网膜下腔出血（aSAH）的相对疗效，目前仍存在知识空白。本研究旨在通过网络荟萃分析，评估不同他汀类药物治疗 aSAH 患者的疗效，并确定其排名。
检索 MEDLINE、Embase、PubMed 和 Cochrane 中央对照试验注册库，检索时间从数据库建立至 2022 年 12 月 15 日。主要结局指标包括迟发性脑缺血（DCI）、功能恢复和死亡率。采用相对危险度（RR）比值及其 95%置信区间（CI）进行估计。通过累积排序曲线下面积（SUCRA）值来获得治疗等级排序。
共纳入 13 项试验，涉及 1885 例患者。阿托伐他汀 20 mg（RR 0.68，95%CI 0.53-0.86）、普伐他汀 40 mg（RR 0.51，95%CI 0.31-0.77）和辛伐他汀 80 mg（RR 0.54，95%CI 0.40-0.70）在预防 DCI 方面优于安慰剂。此外，辛伐他汀 80 mg（RR 0.60，95%CI 0.42-0.84）和普伐他汀 40 mg（RR 0.56，95%CI 0.32-0.93）与 DCI 风险降低相关，优于辛伐他汀 40 mg。不同治疗持续时间的比较表明，短期他汀类药物治疗（RR 0.62，95%CI 0.50-0.76）可降低 DCI 的风险。
辛伐他汀 80 mg 可能是降低 DCI 的最有效干预措施。此外，短期治疗可能会带来更多获益。需要进行更长时间随访的进一步研究来验证本研究结果在高 DCI 风险的 aSAH 患者中的适用性。
