Comparative Efficacy and Safety of Different Tenecteplase Doses With Alteplase in Acute Ischemic Stroke: A Systematic Review With Pairwise and Network Meta‐Analysis to Determine the Optimal Dose
ABSTRACT Background: Tenecteplase (TNK) is a novel thrombolytic agent gaining attention as an alternative to alteplase for treating acute ischemic stroke (AIS). This meta‐analysis evaluates the safety and efficacy of various TNK doses compared to alteplase, integrating recent randomized controlled t...
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Wiley
2025-08-01
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| Series: | Brain and Behavior |
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| Online Access: | https://doi.org/10.1002/brb3.70756 |
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| author | Muhammad Hassan Waseem Zain ul Abideen Muhammad Haris Khan Muhammad Fawad Tahir Marium Khan Hafsa Arshad Azam Raja Ameer Haider Cheema Sania Aimen Muhammad Arslan Tariq Javed Iqbal |
| author_facet | Muhammad Hassan Waseem Zain ul Abideen Muhammad Haris Khan Muhammad Fawad Tahir Marium Khan Hafsa Arshad Azam Raja Ameer Haider Cheema Sania Aimen Muhammad Arslan Tariq Javed Iqbal |
| author_sort | Muhammad Hassan Waseem |
| collection | DOAJ |
| description | ABSTRACT Background: Tenecteplase (TNK) is a novel thrombolytic agent gaining attention as an alternative to alteplase for treating acute ischemic stroke (AIS). This meta‐analysis evaluates the safety and efficacy of various TNK doses compared to alteplase, integrating recent randomized controlled trials (RCTs) and employing a frequentist network meta‐analysis to identify the optimal dose while addressing existing evidence gaps. Methods: Up until December 2024, PubMed, Cochrane Central, and ScienceDirect were searched. Using Review Manager 5.4.1 for pairwise meta‐analysis, the Risk Ratios (RR) with 95% Confidence Intervals (CI) were pooled under the random effects model. Additionally, R version 4.3.2 and the “netmeta” package were used to conduct a network meta‐analysis for various dosages of the two thrombolytic drugs. Results: Thirteen RCTs, pooling 9,044 patients, were included in the quantitative synthesis. TNK was associated with a statistically significant improvement in the excellent functional outcome (mRS 0–1) (RR = 1.04; 95% CI: [1.00, 1.08]; p = 0.03) compared to alteplase. No significant differences were observed between TNK and alteplase in terms of good functional outcome (mRS 0–2), poor functional outcome (mRS 5–6), major neurological improvement within 72 h, symptomatic intracranial hemorrhage (sICH), or mortality at 90 days. On network analysis, TNK 0.25 mg/kg showed significant improvement in excellent functional outcome (RR = 1.05, 95% CI: [1.01, 1.10]) and TNK 0.32 mg/kg in good functional outcome (1.30, 95% CI: [1.15, 1.48]) compared to alteplase. According to the P‐score ranking, TNK 0.25 mg/kg was ranked as the best for achieving an excellent outcome (P‐score = 0.86), and TNK 0.1 mg/kg as the worst (P‐score = 0.16). For symptomatic intracranial hemorrhage (sICH), alteplase 0.9 mg/kg was ranked as the best (P‐score = 0.71), and TNK 0.4 mg/kg as the worst (P‐score = 0.17). Conclusion: TNK (0.25‐0.32 mg/kg) demonstrates superior efficacy compared to alteplase in achieving functional outcomes for AIS, while alteplase remains safer regarding sICH. Optimal dosing favors TNK 0.25 mg/kg for efficacy, but safety considerations highlight the need for individualized thrombolytic selection. |
| format | Article |
| id | doaj-art-bdbac7540a5f4a63b78a16c78d4d2a9a |
| institution | Kabale University |
| issn | 2162-3279 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Wiley |
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| series | Brain and Behavior |
| spelling | doaj-art-bdbac7540a5f4a63b78a16c78d4d2a9a2025-08-20T03:44:18ZengWileyBrain and Behavior2162-32792025-08-01158n/an/a10.1002/brb3.70756Comparative Efficacy and Safety of Different Tenecteplase Doses With Alteplase in Acute Ischemic Stroke: A Systematic Review With Pairwise and Network Meta‐Analysis to Determine the Optimal DoseMuhammad Hassan Waseem0Zain ul Abideen1Muhammad Haris Khan2Muhammad Fawad Tahir3Marium Khan4Hafsa Arshad Azam Raja5Ameer Haider Cheema6Sania Aimen7Muhammad Arslan Tariq8Javed Iqbal9Allama Iqbal Medical College Lahore PakistanKing Edward Medical University Lahore PakistanSaidu Medical College Swat PakistanH.B.S Medical and Dental College Islamabad PakistanJinnah Sindh Medical University Karachi PakistanRawalpindi Medical University Rawalpindi PakistanUT Southwestern Medical Center Texas USAQuetta Institute of Medical Sciences Quetta PakistanAllama Iqbal Medical College Lahore PakistanNursing Department Hamad Medical Corporation Doha QatarABSTRACT Background: Tenecteplase (TNK) is a novel thrombolytic agent gaining attention as an alternative to alteplase for treating acute ischemic stroke (AIS). This meta‐analysis evaluates the safety and efficacy of various TNK doses compared to alteplase, integrating recent randomized controlled trials (RCTs) and employing a frequentist network meta‐analysis to identify the optimal dose while addressing existing evidence gaps. Methods: Up until December 2024, PubMed, Cochrane Central, and ScienceDirect were searched. Using Review Manager 5.4.1 for pairwise meta‐analysis, the Risk Ratios (RR) with 95% Confidence Intervals (CI) were pooled under the random effects model. Additionally, R version 4.3.2 and the “netmeta” package were used to conduct a network meta‐analysis for various dosages of the two thrombolytic drugs. Results: Thirteen RCTs, pooling 9,044 patients, were included in the quantitative synthesis. TNK was associated with a statistically significant improvement in the excellent functional outcome (mRS 0–1) (RR = 1.04; 95% CI: [1.00, 1.08]; p = 0.03) compared to alteplase. No significant differences were observed between TNK and alteplase in terms of good functional outcome (mRS 0–2), poor functional outcome (mRS 5–6), major neurological improvement within 72 h, symptomatic intracranial hemorrhage (sICH), or mortality at 90 days. On network analysis, TNK 0.25 mg/kg showed significant improvement in excellent functional outcome (RR = 1.05, 95% CI: [1.01, 1.10]) and TNK 0.32 mg/kg in good functional outcome (1.30, 95% CI: [1.15, 1.48]) compared to alteplase. According to the P‐score ranking, TNK 0.25 mg/kg was ranked as the best for achieving an excellent outcome (P‐score = 0.86), and TNK 0.1 mg/kg as the worst (P‐score = 0.16). For symptomatic intracranial hemorrhage (sICH), alteplase 0.9 mg/kg was ranked as the best (P‐score = 0.71), and TNK 0.4 mg/kg as the worst (P‐score = 0.17). Conclusion: TNK (0.25‐0.32 mg/kg) demonstrates superior efficacy compared to alteplase in achieving functional outcomes for AIS, while alteplase remains safer regarding sICH. Optimal dosing favors TNK 0.25 mg/kg for efficacy, but safety considerations highlight the need for individualized thrombolytic selection.https://doi.org/10.1002/brb3.70756Alteplasedose analysisnetwork meta‐analysispairwisestrokethrombolytic therapy |
| spellingShingle | Muhammad Hassan Waseem Zain ul Abideen Muhammad Haris Khan Muhammad Fawad Tahir Marium Khan Hafsa Arshad Azam Raja Ameer Haider Cheema Sania Aimen Muhammad Arslan Tariq Javed Iqbal Comparative Efficacy and Safety of Different Tenecteplase Doses With Alteplase in Acute Ischemic Stroke: A Systematic Review With Pairwise and Network Meta‐Analysis to Determine the Optimal Dose Brain and Behavior Alteplase dose analysis network meta‐analysis pairwise stroke thrombolytic therapy |
| title | Comparative Efficacy and Safety of Different Tenecteplase Doses With Alteplase in Acute Ischemic Stroke: A Systematic Review With Pairwise and Network Meta‐Analysis to Determine the Optimal Dose |
| title_full | Comparative Efficacy and Safety of Different Tenecteplase Doses With Alteplase in Acute Ischemic Stroke: A Systematic Review With Pairwise and Network Meta‐Analysis to Determine the Optimal Dose |
| title_fullStr | Comparative Efficacy and Safety of Different Tenecteplase Doses With Alteplase in Acute Ischemic Stroke: A Systematic Review With Pairwise and Network Meta‐Analysis to Determine the Optimal Dose |
| title_full_unstemmed | Comparative Efficacy and Safety of Different Tenecteplase Doses With Alteplase in Acute Ischemic Stroke: A Systematic Review With Pairwise and Network Meta‐Analysis to Determine the Optimal Dose |
| title_short | Comparative Efficacy and Safety of Different Tenecteplase Doses With Alteplase in Acute Ischemic Stroke: A Systematic Review With Pairwise and Network Meta‐Analysis to Determine the Optimal Dose |
| title_sort | comparative efficacy and safety of different tenecteplase doses with alteplase in acute ischemic stroke a systematic review with pairwise and network meta analysis to determine the optimal dose |
| topic | Alteplase dose analysis network meta‐analysis pairwise stroke thrombolytic therapy |
| url | https://doi.org/10.1002/brb3.70756 |
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