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Meta-Analysis
. 2022 Jun;10(3):e00972.
doi: 10.1002/prp2.972.

The efficacy and safety of fingolimod plus standardized treatment versus standardized treatment alone for acute ischemic stroke: A systematic review and meta-analysis

Peng Bai  1 , Runxiu Zhu  1 , Ping Wang  1 , Feng Jiang  1 , Jin Zhen  1 , Yuan Yao  1 , Chenhui Zhao  2 , Zihong Liang  3 , Meiling Wang  1 , Bin Liu  1 , Min Li  1 , Na Li  4 , Jun Yuan  1
Affiliations
Meta-Analysis

The efficacy and safety of fingolimod plus standardized treatment versus standardized treatment alone for acute ischemic stroke: A systematic review and meta-analysis

Peng Bai et al. Pharmacol Res Perspect. 2022 Jun.

Abstract

Acute ischemic stroke (AIS) is the most common type of stroke. Fingolimod is a sphingosine analog that acts on sphingosine-1-phosphate receptors (S1PR). Recently, the safety and efficacy of fingolimod in both patients with intracerebral hemorrhage and patients with AIS have been investigated in proof-of-concept trials. In this review, we performed a meta-analysis to evaluate the efficacy and safety of fingolimod for AIS. This study was conducted according to the PRISMA (Preferred Reporting Items for Systemic review and Meta-Analysis) statement. We searched for publications on the PubMed, Embase, Cochrane Central Register of Controlled Trials, Clinical trials, CNKI, Wanfang Data, VIP, CBM up to August 2021. We compiled five studies; a main meta-analysis forest plots were conducted for the values of the proportion of patients whose modified Rankin scale (MRS) score was 0-1 at day 90. There were heterogeneities in each study; the method of sensitivity analysis was performed. A sensitivity analysis was performed with a mean difference (MD) of the efficacy of fingolimod plus standardized treatment versus standardized treatment alone. Random effect model is used for meta-analysis regardless of the I2 index. The analysis was carried out for categorical variables using the risk ratio (RR), LogRR, and its 95% CI. The methodological quality of each randomized controlled trial (RCTs) was assessed according to the Cochrane Collaboration tool to assess the risk of bias (ROB). A meta-analysis of five studies with 228 participants was conducted. The risk ratio of patients whose MRS score was 0-1 at day 90 between fingolimod plus standardized treatment and standardized treatment alone was 2.59 (95%CI, 1.48-4.56). The Fingolimod plus standard treatment group decreased infarct growth and improved clinical function than the standard treatment.

Keywords: acute ischemic stroke; fingolimod; meta-analysis; modified rankin scale.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart presenting the process of the study selection for fingolimod meta‐analysis.
FIGURE 2
FIGURE 2
Risk of bias summary for included studies. A “+” stands for low risk, “–” for high risk, and “?” for unclear risk.
FIGURE 3
FIGURE 3
(A) Forest plot of the risk ratio of the proportion of patients whose MRS score was 0–1 at day 90, (B) the mean difference in the change in MRS score at day 90 between fingolimod plus standardized treatment and standardized treatment alone.
FIGURE 4
FIGURE 4
(A) Forest plot of the mean difference in the change in NIHSS score at 24 h, (B) NIHSS score at day 7, (C) CNIHSS score at day 90, (D) relative infarct lesion growth at 24 h, (E) relative infarct lesion growth at day 7 between fingolimod plus standardized treatment and standardized treatment alone.
See this image and copyright information in PMC

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