Tenecteplase versus alteplase for acute ischaemic stroke:a meta-analysis of phaseⅢrandomised trials  

作　　者：Yunyun Xiong Liyuan Wang Guangshuo Li Kai-Xuan Yang Manjun Hao Shuya Li Yuesong Pan Yongjun Wang 

机构地区：[1]Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing,China [2]China National Clinical Research Center for Neurological Diseases,Beijing,China [3]Chinese Institute for Brain Research,Beijing,China [4]Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease,Beijing,China

出　　处：《Stroke & Vascular Neurology》2024年第4期360-366,I0001-I0021,共28页卒中与血管神经病学（英文）

基　　金：supported by grants from The National Natural Science Foundation(82171272);Beijing Municipal Science and Technology Committee(Z211100003521019);Beijing Hospitals Authority(PX2022019).

摘　　要：Background Tenecteplase(TNK)was found non-inferior to alteplase in recent clinical trials.We aimed to elucidate the efficacy and safety of TNK versus alteplase for acute ischaemic stroke(AIS).Methods Systematic literature search and a meta-analysis of phaseⅢclinical trials in ischaemic stroke patients with TNK use were conducted.The primary outcome was excellent functional outcome which was defined as modified Rankin Scale score of 0–1 at 90 days and safety outcomes included symptomatic intracerebral haemorrhage and death at 90 days.We used random-effects model to estimate the pooled risk difference and 95%CI in R package‘Meta’.The included trials were adapted to the non-inferiority analysis with a margin of-4%.Results Three trials enrolling 4094 patients were identified by systematic search.All trials included AIS patients within 4.5hours time window.Meta-analysis indicated that 1089(53.0%)of 2056 patients in the TNK arm and 1016(50.5%)of 2012 in the alteplase arm had excellent functional outcome at 90 days(0.03(95%CI-0.00 to 0.06);I^(2)=0%),meeting the prespecified non-inferiority threshold.And TNK thrombolysis was not correlated with increased risk of symptomatic intracerebral haemorrhage(0.00(95%CI-0.01 to 0.01);I^(2)=0%)or death(0.01(95%CI-0.01 to 0.02);I^(2)=0%)at 90 days.The sensitivity analysis with the 0.25mg/kg trials exclusively showed similar results to the main analysis.Conclusions TNK was non-inferior to alteplase for achieving excellent functional outcome at 90 days without increasing the safety concern in treating patients with AIS.These findings suggest that TNK can be an alternative to alteplase.

关 键 词：analysis RANDOM PHASE 

分 类 号：R743.3[医药卫生—神经病学与精神病学]