Practice advisory: Etanercept for poststroke disability: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.
OBJECTIVE
To review evidence regarding the effectiveness, safety, and tolerability of etanercept used to treat patients with poststroke disability.


METHODS
We searched MEDLINE and the Cochrane Central Register of Controlled Trials for studies of adult patients with poststroke disability treated with etanercept in order to improve their functional status. We rated each study for risk of bias (Class I-IV) using the American Academy of Neurology therapeutic classification of evidence scheme. Practice recommendations were formulated on the basis of the strength of the evidence and assessments of potential benefits, potential harms, and patient preferences.


RESULTS
Two case series were identified, and both reported clinical improvements 3 weeks following treatment across a wide range of functional domains. However, both studies were rated Class IV because of poor methodologic quality (i.e., high risk of bias).


CONCLUSIONS
For patients with poststroke disability, the evidence is insufficient to support or refute a benefit of etanercept for the treatment of poststroke disability.


CONCLUSIONS
Clinicians should counsel patients considering etanercept for treatment of poststroke disability that the evidence is insufficient to determine the treatment's effectiveness and that it may be associated with adverse outcomes and high cost (Level U).
From the Department of Neurology (G.S.G.), University of Kansas Medical Center, Kansas City; and the Department of Neurology (S.R.M.), University of Pennsylvania School of Medicine, Philadelphia.
Gary S
GS
Gronseth
From the Department of Neurology (G.S.G.), University of Kansas Medical Center, Kansas City; and the Department of Neurology (S.R.M.), University of Pennsylvania School of Medicine, Philadelphia.
Steven R
SR
Messé
D002986:Clinical Trials as Topic; D000068800:Etanercept / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D018696:Neuroprotective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D020521:Stroke / Q000188:drug therapy*
D018696:Neuroprotective Agents; D000068800:Etanercept