Efficacy and safety of nicardipine prolonged-release implants in patients with aneurysmal subarachnoid hemorrhage: A meta-analysis of randomized controlled trials

Abstract

Cerebral vasospasm (CV) is a major complication following aneurysmal subarachnoid hemorrhage (aSAH), significantly contributing to morbidity and mortality. Nicardipine Prolonged-Release Implants (NPRI) offer targeted, localized drug delivery to prevent CV. This meta-analysis evaluated NPRI's efficacy and safety in reducing CV, mortality, and adverse events in patients with aSAH undergoing aneurysm repair. A systematic review and meta-analysis followed PRISMA guidelines. We searched PubMed, Embase, and Cochrane (inception-November 2024). Included RCTs compared NPRI plus standard care vs. standard care alone. Outcomes: CV, mortality, and adverse events. A random-effects model calculated risk ratios (RR) with 95% confidence intervals (CI). Heterogeneity was assessed via I². Registered in PROSPERO (CRD42024629347). From 214 identified records, three RCTs comprising 84 patients (NPRI group: 45; control group: 39) met inclusion criteria. NPRI significantly reduced CV incidence (RR, 0.24 [95% CI, 0.09-0.60]; P = .002) with low heterogeneity (I² = 37%). Mortality was also significantly reduced in the NPRI group (RR, 0.18 [95% CI, 0.03-0.95]; P = .044; I² = 0%). Adverse events were less frequent in the NPRI group (RR, 0.42 [95% CI, 0.18-0.97]; P = .043; I² = 0%). This meta-analysis provides preliminary evidence supporting NPRI to reduce CV, mortality, and adverse events in aSAH. Despite the small number of included studies, low heterogeneity and significant effect sizes suggest NPRI as a promising intervention. Larger-scale RCTs with extended follow-up are required to validate these findings and define NPRI's role in clinical practice.

Keywords: Aneurysmal subarachnoid hemorrhage; Cerebral vasospasm; Meta-analysis.