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. 2023 Mar;8(1):93-105.
doi: 10.1177/23969873221129924. Epub 2022 Oct 13.

Different dosing regimens of Tenecteplase in acute ischemic stroke: A network meta-analysis of the clinical evidence

Ei Zune The  1 , Ne Naing Lin  2 , Mazen Matar  1 , Hock Luen Teoh  3 , Leonard Leong Litt Yeo  3
Affiliations

Different dosing regimens of Tenecteplase in acute ischemic stroke: A network meta-analysis of the clinical evidence

Ei Zune The et al. Eur Stroke J. 2023 Mar.

Abstract

Introduction: Acute ischemic stroke remains the major cause of death and disability and conclusive evidence of Tenecteplase in treating stroke is lacking.

Objective: To conduct a meta-analysis to determine whether Tenecteplase produces better outcomes than Alteplase and a network meta-analysis comparing the different dosing regimens of Tenecteplase.

Methods: Searches were made in MEDLINE, CENTRAL, and ClinicalTrials.gov. The outcome measures are recanalization, early neurological improvement, functional outcomes at 90 days (modified Rankin Scale 0-1 and 0-2), intracranial hemorrhage, symptomatic intracranial hemorrhage, and mortality within 90 days from treatment.

Results: Fourteen studies are included in the meta-analyses and 18 studies in the network meta-analyses. In the meta-analysis, Tenecteplase 0.25 mg/kg has significant results in early neurological improvement (OR = 2.35, and 95% CI = 1.16-4.72) and excellent functional outcome (OR = 1.20, and 95% CI = 1.02-1.42). In the network meta-analysis, Tenecteplase 0.25 mg/kg produces significant results in early neurological improvement (OR = 1.52 [95% CI = 1.13-2.05], p-value = 0.01), functional outcomes (mRS 0-1 and 0-2) (OR = 1.19 [95% CI = 1.03-1.37], p-value = 0.02; OR = 1.21 [95% CI = 1.05-1.39], p-value = 0.01; respectively) and mortality (OR = 0.78 [95% CI = 0.64-0.96], p-value = 0.02) whereas Tenecteplase 0.40 mg/kg increases the chances of symptomatic intracranial hemorrhage (OR = 2.35 [95% CI = 1.19-4.64], p-value = 0.01).

Conclusion: While not conclusive, our study lends evidence to 0.25 mg/kg Tenecteplase dose for ischemic stroke treatment. Further randomized trials need to be done to validate this finding.

Registration: International prospective register of systematic reviews (PROSPERO) - CRD42022339774URL: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339774.

Keywords: Alteplase; Tenecteplase; meta-analysis; network meta-analysis; stroke.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Forest plots of functional outcomes: (a) recanalization and (b) early neurological improvement.
Figure 2.
Figure 2.
Network meta-analysis results on (a) Recanalization, (b) Early neurological improvement, (c) Excellent functional outcome (mRS 0–1) at day 90, (d) Good functional outcome (mRS 0–2) at day 90, (e) Intracranial hemorrhage (ICH), (f) Symptomatic intracranial hemorrhage (SICH).
Figure 3.
Figure 3.
Forest plots of functional outcomes. (a) Excellent functional outcome (mRS 0–1) at day 90. (b) Good functional outcome (mRS 0–2) at day 90.
Figure 4.
Figure 4.
Forest plots of safety outcomes: (a) Intracranial hemorrhage (ICH) and (b) symptomatic intracranial hemorrhage (SICH).
Figure 5.
Figure 5.
(a) Forest plot of Mortality within 90 days, (b) Network meta-analysis results on Mortality within 90 days.
See this image and copyright information in PMC

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