Minocycline for acute stroke treatment: a systematic review and meta-analysis of randomized clinical trials

Background Various randomized-controlled clinical trials (RCTs) have investigated the neuroprotective role of minocycline in acute ischemic stroke (AIS) or acute intracerebral hemorrhage (ICH) patients. We sought to consolidate and investigate the efficacy and safety of minocycline in patients with ...

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Vydáno v:Journal of neurology Ročník 265; číslo 8; s. 1871 - 1879
Hlavní autoři: Malhotra, Konark, Chang, Jason J., Khunger, Arjun, Blacker, David, Switzer, Jeffrey A., Goyal, Nitin, Hernandez, Adrian V., Pasupuleti, Vinay, Alexandrov, Andrei V., Tsivgoulis, Georgios
Médium: Journal Article
Jazyk:angličtina
Vydáno: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2018
Springer Nature B.V
Témata:
Antibiotics
Brain Ischemia - drug therapy
Cerebral Hemorrhage - drug therapy
Cerebral infarction
Clinical trials
Hemorrhage
Humans
Ischemia
Medicine
Medicine & Public Health
Meta-analysis
Minocycline
Minocycline - therapeutic use
Myocardial infarction
Neuroimaging
Neurology
Neuroprotection
Neuroprotective Agents - therapeutic use
Neuroradiology
Neurosciences
Original Communication
Patients
Randomized Controlled Trials as Topic
Safety
Stroke
Stroke - drug therapy
Systematic review
Minocycline
Ischemic stroke
Recovery
Intracerebral hemorrhage
ISSN:0340-5354, 1432-1459, 1432-1459
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Shrnutí:Background Various randomized-controlled clinical trials (RCTs) have investigated the neuroprotective role of minocycline in acute ischemic stroke (AIS) or acute intracerebral hemorrhage (ICH) patients. We sought to consolidate and investigate the efficacy and safety of minocycline in patients with acute stroke. Methods Literature search spanned through November 30, 2017 across major databases to identify all RCTs that reported following efficacy outcomes among acute stroke patients treated with minocycline vs. placebo: National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), and modified Rankin Scale (mRS) scores. Additional safety, neuroimaging and biochemical endpoints were extracted. We pooled mean differences (MD) and risk ratios (RR) from RCTs using random-effects models. Results We identified 7 RCTs comprising a total of 426 patients. Of these, additional unpublished data was obtained on contacting corresponding authors of 5 RCTs. In pooled analysis, minocycline demonstrated a favorable trend towards 3-month functional independence (mRS-scores of 0–2) (RR = 1.31; 95% CI 0.98–1.74, p  = 0.06) and 3-month BI (MD = 6.92; 95% CI − 0.92, 14.75; p  = 0.08). In AIS subgroup, minocycline was associated with higher rates of 3-month mRS-scores of 0–2 (RR = 1.59; 95% CI 1.19–2.12, p  = 0.002; I 2  = 58%) and 3-month BI (MD = 12.37; 95% CI 5.60, 19.14, p  = 0.0003; I 2  = 47%), whereas reduced the 3-month NIHSS (MD − 2.84; 95% CI − 5.55, − 0.13; p  = 0.04; I 2  = 86%). Minocycline administration was not associated with an increased risk of mortality, recurrent stroke, myocardial infarction and hemorrhagic conversion. Conclusions Although data is limited, minocycline demonstrated efficacy and seems a promising neuroprotective agent in acute stroke patients, especially in AIS subgroup. Further RCTs are needed to evaluate the efficacy and safety of minocycline among ICH patients.
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ISSN:0340-5354
1432-1459
1432-1459
DOI:10.1007/s00415-018-8935-3