Edaravone slightly improves neurological symptoms in stroke patients
Treatment with edaravone yields improvements in neurological symptoms in patients with ischaemic stroke of any subtype, although the effect is small and has limited clinical significance, according to a recent study.
The study used data from the Japan Stroke Data Bank and included 61,048 adult patients who were hospitalized ≤14 days after onset of an acute ischaemic stroke. Reasons for stroke were large-artery atherosclerosis (32.7 percent) or small-vessel occlusion (31.4 percent) in most patients, cardioembolism in 28.0 percent and cryptogenic/undetermined in 7.9 percent.
Neurological symptoms during the hospital stay, evaluated using the National Institutes of Health Stroke Scale (NIHSS), was the primary outcome. Changes in NIHSS scores from admission to discharge were more favourable in the edaravone-treated group than in the no-edaravone control group across all ischaemic stroke subtypes (mean ΔNIHSS: −0.46, 95 percent CI, −0.75 to −0.16 for large-artery atherosclerosis; −0.64, −1.09 to −0.2 for cardioembolism; and −0.25, −0.4 to −0.09 for small-vessel occlusion).
Edaravone produced the greatest effect in the most severely affected patients (NIHSS score ≥15 at admission) with large-artery atherosclerosis or cardioembolism stroke subtypes (mean ΔNIHSS: −0.46, −0.70 to −0.22 for large-artery atherosclerosis; −0.89, −1.27 to −0.51 for cardioembolism; and −0.30, −0.42 to −0.17 for small-vessel occlusion).
A ≥4-point improvement in NIHSS score is considered to be clinically meaningful, but the point estimate of the mean difference in ΔNIHSS observed in the current study was <1, researchers noted. This indicates that the edaravone-led improvement in neurological symptoms may have limited clinical impact.
It may then be useful to selectively target patients who will gain the most from edaravone, the researchers added. In light of the results, clinicians may wish to consider restricting the use of the drug to those with an NIHSS score of ≥15 points at the time of admission.