Edaravone for acute ischaemic stroke

Most strokes take place when a blood clot blocks a blood vessel leading to the brain. Without a proper blood supply, the brain quickly suffers damage, which can be permanent. The damage from a stroke can cause arm or leg weakness, or difficulties with language or vision. Data from some experimental and human studies have suggested that edaravone, a neuroprotective agent, may be beneficial for people with acute ischaemic stroke. It has been widely used in China to treat stroke. To obtain a reliable assessment of the effects of edaravone in acute ischaemic stroke, we reviewed data from three studies involving 496 participants. The quality of the trials was moderate. It would appear that edaravone is an effective treatment for acute ischaemic stroke. However, more high-quality and bigger sample trials are needed to confirm this result.

Authors' conclusions: 

The risk of bias in the included trials was moderate and the sample was small. Hence, although the data in this review show an effective treatment trend of edaravone for acute ischaemic stroke, further large, high-quality trials are required to confirm this trend.

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Background: 

Neuroprotection is a promising therapeutic strategy for the treatment of acute ischaemic stroke. Edaravone is a neuroprotective agent that has been widely used in China, and several studies have suggested that it may be beneficial in acute ischaemic stroke.

Objectives: 

To assess the efficacy and safety of edaravone for acute ischaemic stroke.

Search strategy: 

We searched the Cochrane Stroke Group Trials Register (November 2010) and the Chinese Stroke Trials Register (November 2010). In addition, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE (1950 to November 2010), EMBASE (1980 to November 2010), China National Knowledge Infrastructure (1979 to November 2010), Chinese Biomedical Database (1979 to November 2010), Chinese Evidence-Based Medicine Database (November 2010) and Chinese Science and Technology Journals Database (1980 to November 2010). In an attempt to identify further published, unpublished and ongoing trials we searched reference lists and clinical trials and research registers, and contacted a pharmaceutical company, researchers and study authors.

Selection criteria: 

We included randomised controlled trials comparing edaravone with placebo or no intervention in patients with acute ischaemic stroke.

Data collection and analysis: 

Two review authors selected trials for inclusion, assessed trial quality and independently extracted the data.

Main results: 

We included three trials, involving 496 participants, and defined four trials as waiting assessment. All three included trials were of edaravone plus another treatment compared with the other treatment alone. The dose of edaravone injections in the three trials was the same at 60 mg per day. The course of treatment in all three trials is 14 days. None of the included trials reported the pre-specified primary outcome of death or dependency defined using the modified Rankin scale during the follow-up period. The three trials evaluated the effect of edaravone at different times and using different methods. All three trials reported adverse events; there were no differences between the treatment group and the control group. Overall, edaravone appeared to increase the proportion of participants with marked neurological improvement compared with the control group, and the difference was significant (risk ratio (RR) 1.99, 95% confidence interval (CI) 1.60 to 2.49).

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