Safety and Efficacy of Riluzole in Traumatic Spinal Cord Injury: A Systematic Review With Meta-Analyses

Abstract

Traumatic spinal cord injury (SCI) is a cause of significant morbidity, often resulting in long-term disability. We aimed to compare outcomes after riluzole versus patients who received placebo or standard of care with no specific intervention. MEDLINE, Embase, Scopus, and Cochrane Library database searches yielded 92 records, and five met the study inclusion criteria. Fixed-effect and random-effects models were used to establish odds ratios (ORs) and mean difference (MD) with 95% confidence intervals (CIs) for each outcome. The results of the pooled analysis showed that in patients with acute traumatic SCI, riluzole resulted in increased American Spinal Injury Association (ASIA) motor scores at 3 months (MD 0.26, 95% CI [-0.10,0.61], I² = 0%; p = 0.157) and 6 months (MD 0.21, 95% CI [-0.17,0.60], I² = 0%; p = 0.280) and change in ASIA Impairment Scale (AIS) at 3 months (OR 0.59, 95% CI [-0.12,1.30], I² = 0%, p = 0.101) and 6 months (OR 0.28, 95% CI [-0.50,1.06], I² = 0%, p = 0.479) in comparison to the control groups, though not to a level of statistical significance. Riluzole resulted in fewer adverse events than the control groups (OR -0.12, 95% CI [-1.59,1.35], I² = 0%, p = 0.874) and lower mortality (OR -0.20, 95% CI [-1.03,0.63], I² = 0%, p = 0.640), though also not to a level of statistical significance. These meta-analyses suggest that riluzole for the treatment of traumatic SCI is safe and results in improved neurological outcomes when compared to controls, though not to a level of statistical significance. More robust prospective, randomized studies are necessary to help inform the safety and efficacy of riluzole for traumatic SCI.

Keywords: riluzole; spinal cord injury; trauma.

FIG. 1.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart).

FIG. 2.

Forest plot demonstrating fixed-effects model for change in AIS at 3 months in patients who received riluzole in comparison to control for traumatic SCI.^,, OR, odds ratio; CI, confidence interval; FE, fixed-effects.

FIG. 3.

Forest plot demonstrating fixed-effect model for change in AIS at 6 months in patients who received riluzole in comparison to control for traumatic SCI.^,, OR, odds ratio; CI, confidence interval; FE, fixed-effects.

FIG. 4.

Forest plot demonstrating fixed-effect models for MD of baseline ASIA motor scores in patients with traumatic SCI who received riluzole in comparison to control.^,, CI, confidence interval; FE, fixed-effects.

FIG. 5.

Forest plot demonstrating fixed-effects model for MD in ASIA motor score at 3 months in patients with traumatic SCI who received riluzole in comparison to control.^,, CI, confidence interval; FE, fixed-effects.

FIG. 6.

Forest plot demonstrating fixed-effects model for MD in ASIA motor score at 6 months in patients with traumatic SCI who received riluzole in comparison to control.^,, CI, confidence interval; FE, fixed-effects.

FIG. 7.

Forest plot demonstrating fixed-effects model for adverse events in patients who received riluzole in comparison to control for traumatic SCI. OR, odds ratio; CI, confidence interval; FE, fixed-effects.

FIG. 8.

Forest plot demonstrating fixed-effects model for mortality in patients who received riluzole in comparison to control for traumatic SCI. OR, odds ratio; CI, confidence interval; FE, fixed-effects.