For individuals who have had an ischemic stroke, treatment with the clot-busting drug tenecteplase is barely more prone to have excellent recovery and reduced disability three months later than treatment with alteplase, in response to a meta-analysis published on October 16, 2024. online edition Neurology^®medical journal of the American Academy of Neurology. The researchers found that the likelihood of excellent recovery was similar for each treatments.

Ischemic stroke is attributable to blockage of blood flow to the brain and is essentially the most common sort of stroke.

Alteplase is the one drug approved by the U.S. Food and Drug Administration (FDA) for the treatment of ischemic stroke. Tenecteplase, a more recent clot-busting drug, has been approved for the treatment of ischemic stroke in Europe but not in the USA. It’s approved within the US for the treatment of clots blocking coronary arteries and is used off-label to treat ischemic stroke in some stroke centers.

Tenecteplase or alteplase could also be utilized in patients with ischemic stroke. Although treatment with either drug increases the chances of a very good recovery from a stroke, we found that those given tenecteplase were more prone to have a superb recovery.”

Georgios Tsivgoulis MD, PhD, MSc, study creator on the National and Kapodistrian University of Athens, Greece, and member of the American Academy of Neurology

For the meta-analysis, researchers reviewed 11 studies that compared the protection and effectiveness of treatment with tenecteplase or alteplase inside 4 and a half hours after stroke. In these studies, 3,788 people were treated with tenecteplase and three,757 people were treated with alteplase.

The researchers checked the participants’ recovery after three months. They used a scale with a rating from zero to 6, where zero means no symptoms and 6 means death. Perfect recovery was defined as a rating of zero to at least one, with one being no significant disability despite some symptoms. Good recovery was defined as a rating of zero to 2, where two indicates mild disability, where someone is unable to perform all previous tasks but can care for themselves without assistance. Reduced disability was defined as a decrease of a number of points on the dimensions after three months.

The researchers found that folks given tenecteplase were 5% more prone to have an ideal recovery in comparison with those given alteplase, and likewise 10% more prone to have reduced disability three months after the stroke. The possibilities of a very good recovery were similar in each groups.

“Our meta-analysis shows that while each drugs have similar safety and increase the possibilities of excellent recovery from stroke, tenecteplase has a bonus over alteplase, providing a greater probability of wonderful recovery and fewer disability,” Tsivgoulis said. “Our findings support using tenecteplase as a substitute of alteplase within the treatment of individuals with ischemic stroke.”

A limitation of the meta-analysis was that even though it included all available randomized controlled trials of tenecteplase and alteplase, three of the 11 studies had been presented at scientific conferences but had not yet been published in a scientific journal.