For those experiencing an ischemic stroke, a recent meta-analysis indicates that the clot-dissolving medication tenecteplase might enhance the likelihood of significant recovery and lower disability three months after the event, compared to the drug alteplase. However, the chances of achieving a good recovery were found to be comparable for both treatments.
According to a meta-analysis published in the October 16, 2024, online edition of Neurology®, the medical journal of the American Academy of Neurology, patients with ischemic stroke treated with the clot-busting medication tenecteplase experience a slightly greater chance of achieving excellent recovery and experiencing less disability three months later compared to those treated with alteplase. Despite this, researchers found that the likelihood of good recovery was similar for both medications.
Ischemic stroke occurs due to a blockage that restricts blood flow to the brain and is recognized as the most prevalent type of stroke.
The only drug approved by the U.S. Food and Drug Administration (FDA) for treating ischemic stroke is alteplase. While tenecteplase is a newer clot-dissolving drug approved for ischemic stroke in Europe, it has not been authorized for that use in the U.S. It is, however, FDA-approved for treating blocked coronary arteries and is sometimes used off-label for ischemic stroke in certain stroke centers.
“Patients suffering from ischemic stroke can receive treatment with either tenecteplase or alteplase,” remarked study author Georgios Tsivgoulis MD, PhD, MSc, from the National and Kapodistrian University of Athens in Greece and a Fellow of the American Academy of Neurology. “While both drugs enhance the chances of a positive recovery after a stroke, we found that individuals treated with tenecteplase were more likely to achieve an excellent recovery.”
For their analysis, researchers scrutinized 11 studies that evaluated the safety and effectiveness of tenecteplase versus alteplase within four-and-a-half hours following a stroke. A total of 3,788 participants received tenecteplase, while 3,757 were treated with alteplase.
The researchers assessed the participants’ recovery after three months using a scale ranging from zero to six, where zero means no symptoms and six indicates death. An excellent recovery was categorized as a score of zero to one, where one signifies no substantial disability despite minor symptoms. A good recovery was recorded as a score of zero to two, with two signifying slight disability where an individual can still care for themselves independently but can’t perform all previous activities. Reduced disability was defined as a one-point or more decrease on the scale at the three-month mark.
Results showed that those who received tenecteplase had a 5% greater chance of achieving excellent recovery compared to those administered alteplase, along with a 10% better chance of experiencing reduced disability three months post-stroke. The likelihood of a good recovery was relatively equivalent between the two treatment groups.
“Our meta-analysis indicates that while both medications exhibit similar safety profiles and enhance the likelihood of good recovery post-stroke, tenecteplase offers distinct advantages over alteplase, including a higher chance of excellent recovery and decreased disability,” explained Tsivgoulis. “These findings advocate for the preference of tenecteplase over alteplase in the treatment of ischemic stroke.”
It should be noted that a limitation of the meta-analysis was the inclusion of studies that, while randomized and controlled, had not been officially published in a scientific journal, with three out of the eleven studies only presented at scientific conferences.
