Oral citicoline in acute ischemic stroke: an individual patient data pooling analysis of clinical trials.
OBJECTIVE
No single neuroprotective agent has been shown to influence outcome after acute stroke. Citicoline has been studied worldwide in many clinical trials with positive findings, but only 1 trial has obtained significant results in the primary efficacy variables. Our objective was to evaluate the effects of oral citicoline in patients with acute ischemic stroke by a data pooling analysis of clinical trials. The primary efficacy end point chosen was the common evaluation of recovery, combining National Institutes of Health Stroke Scale </=1, modified Rankin Scale score </=1, and Barthel Index >/=95 at 3 months using the generalized estimating equations analysis.


METHODS
A systematic search of all prospective, randomized, placebo-controlled, double-blind clinical trials with oral citicoline (MEDLINE, Cochrane, and Ferrer Group bibliographic databases) was undertaken. Individual patient data were extracted from each study and pooled in a single data file. The main inclusion criteria included compatible neuroimaging with ischemic stroke, National Institutes of Health Stroke Scale >/=8, and prior modified Rankin Scale score </=1. Four clinical trials using various doses of oral citicoline (500, 1000, and 2000 mg) were identified.


RESULTS
Of 1652 randomized patients, 1372 fulfilled the inclusion criteria (583 received placebo, 789 received citicoline). Recovery at 3 months was 25.2% in citicoline-treated patients and 20.2% in placebo-treated patients (odds ratio [OR], 1.33; 95% CI, 1.10 to 1.62; P=0.0034). The dose showing the largest difference with placebo was 2000 mg, with 27.9% of patients achieving recovery (OR, 1.38; 95% CI, 1.10 to 1.72; P=0.0043). The overall safety of citicoline was similar to placebo.


CONCLUSIONS
Treatment with oral citicoline within the first 24 hours after onset in patients with moderate to severe stroke increases the probability of complete recovery at 3 months.
Dávalos
Antoni
A
Department of Neurology, Hospital Universitari Doctor Josep Trueta, Girona, Spain. min.adavalos@htrueta.scs.es
Castillo
José
J
Alvarez-Sabín
José
J
Secades
Julio J
JJ
Mercadal
Joan
J
López
Sonia
S
Cobo
Erik
E
Warach
Steven
S
Sherman
David
D
Clark
Wayne M
WM
Lozano
Rafael
R
D000208:Acute Disease; D000284:Administration, Oral; D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D003566:Cytidine Diphosphate Choline / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D018696:Neuroprotective Agents / Q000008:administration & dosage*; D016017:Odds Ratio; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D020127:Recovery of Function / Q000187:drug effects; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome
D018696:Neuroprotective Agents; D003566:Cytidine Diphosphate Choline