The efficacy and safety of tenecteplase compared with alteplase in adult patients with acute ischemic stroke: an updated systematic review and meta-analysis of ten randomized controlled trials

Abstract

Abstract Background Alteplase (tPA) is the only thrombolytic agent approved by the USFDA for acute ischemic stroke (AIS). Various randomized controlled trials (RCTs) have reported that Tenecteplase (TNK) is non-inferior to tPA resulting in its approval in various countries. We compared the efficacy and safety of TNK with tPA in adult patients with AIS by performing an updated systematic review and meta-analysis of recently published RCTs. Thus, PubMed and Cochrane databases were searched for RCTs until April 27, 2023. Data is represented as log-odds ratio (logOR) with 95% confidence interval (CI). The efficacy outcome measures included early neurological improvement (ENI), recanalization, functional outcomes at 90-days (modified Rankin Scale (mRS) 0–1 and 0–2), any intracranial hemorrhage (ICH), symptomatic ICH, and mortality within 90-days. Results Ten RCTs involving 5105 adult patients with AIS were included. The rates of ENI (logOR: 0.11; 95%CI: − 0.02, 0.23; p-value: 0.09), recanalization (logOR: 0.33; 95%CI: − 0.02, 0.68; p-value: 0.07), mRS 0–1 at 90-days (logOR: 0.09; 95%CI: − 0.02, 0.21; p-value: 0.11), and mRS 0–2 at 90-days (logOR: 0.07; 95%CI: − 0.29, 0.44; p-value: 0.70) were comparable among TNK and tPA. Similarly, TNK and tPA were comparable regarding any ICH (logOR: 0.06; 95%CI: − 0.11, 0.24; p-value: 0.47), symptomatic ICH (logOR: − 0.14; 95%CI: − 0.47, 0.20; p-value: 0.42), and all-cause mortality (logOR: − 0.04; 95%CI: − 0.23, 0.15; p-value: 0.70). Conclusions Based on the included RCTs, TNK is comparable to tPA regarding efficacy and safety. Thus, TNK can be recommended as an alternative to tPA in adult patients with AIS.

Keywords

• Alteplase
• Ischemic stroke
• Meta-analysis
• Tenecteplase
• TNK
• tPA