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The following is a summary of “Tenecteplase vs Alteplase in Acute Ischemic Stroke Within 4.5 Hours: A Systematic Review and Meta-Analysis of Randomized Trials,” published in the October 2024 issue of Neurology by Palaiodimou et al.
The European Stroke Organization recommends tenecteplase (TNK) as an alternative to alteplase (tissue plasminogen activator [TPA]) for treating acute ischemic stroke (AIS) within 4.5 hours based on meta-analysis showing noninferiority.
Researchers conducted a prospective study comparing the efficacy and safety of TNK and alteplase in patients with AIS.
They performed a systematic review and meta-analysis, including all available RCTs investigating TNK 0.25 mg/kg vs. TPA for treating AIS within 4.5 hours. The primary outcome was excellent functional outcome at 3 months (modified Rankin Scale [mRS] score 0–1), while secondary outcomes included good functional outcome (mRS score 0–2), reduced disability at 3 months (≥1-point reduction across all mRS scores), symptomatic intracranial hemorrhage (sICH), and 3-month mortality. Pooled analyses were calculated using a random-effects model.
The results showed 11 RCTs comprising a total of 3,788 patients treated with TNK vs. 3,757 patients treated with alteplase found that TNK was linked with a higher likelihood of achieving an excellent functional outcome (risk ratio [RR] 1.05, 95% CI 1.01–1.10; P=0.012; I2 = 0%; risk difference 2.95%; 95% CI 0.76%–5.14%; P=0.008; I2 = 0%) and reduced disability at 3 months (common OR 1.10, 95% CI 1.01–1.19; P=0.034; I2 = 0%) compared with alteplase, while good functional outcome (RR 1.03, 95% CI 0.99–1.07; P=0.142; I2 = 28%) was similar between the groups. Safety outcomes showed similar rates of symptomatic intracranial hemorrhage (RR 1.12, 95% CI 0.83–1.53; P=0.456; I2 = 0%) and 3-month mortality (RR 0.97, 95% CI 0.82–1.15; P=0.727; I2 = 12%).
They concluded that TNK 0.25 mg/kg was superior to alteplase in terms of excellent functional outcomes and reduced disability at 3 months, with similar safety profiles between the 2 treatments.
Source: neurology.org/doi/10.1212/WNL.0000000000209903
