Efficacy and Safety of Therapies for Acute Ischemic Stroke in China: A Network Meta-Analysis of 13289 Patients from 145 Randomized Controlled Trials

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Date: Feb. 13, 2014
From: PLoS ONE(Vol. 9, Issue 2)
Publisher: Public Library of Science
Document Type: Article
Length: 4,411 words
Lexile Measure: 1510L

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Author(s): Bowen Yang, Jingpu Shi *, Xin Chen, Bing Ma, Hao Sun

Introduction

Stroke is the second most common cause of death and the major cause of disability worldwide, preceded only by heart attack. The burden of stroke will increase greatly in the next 20 years, especially in developing countries, due to the aging of population [1]. About 80% of all acute strokes are caused by cerebral infarction, usually resulting from thrombotic or embolic occlusion of a cerebral artery [2]. In addition, China must face the greatest number of cases of stroke due to its 1.34 billion population accounted for as of 2011 [3]. The epidemiological data shows that from 1984 to 2004 the incidence of ischemic stroke as the most common subtype, representing about 80% of all strokes, and has increased by 8.7% per year even though the incidence of hemorrhagic stroke decreased by 1.7% every year in China [3]. Guideline from the American Heart Association/American Stroke Association for the patients' early management of acute ischemic stroke remains multifaceted, and includes several aspects of care that have not been tested in clinical trials [4]. Although data from some experimental and human studies have suggested that edaravone and Sodium ozagrel, the neuroprotective agent, may be beneficial for people with acute ischemic stroke, It has been widely used in China to treat stroke [5], [6], the comparisons of these drugs or combined treatments were unclear.

Network meta-analysis is an extension of traditional meta-analysis as well as a method that synthesizes available evidence to allow for simultaneous comparisons of different treatment options that lack direct head-to-head evaluations [7]-[10]. Individual pair-wise studies are 'linked' to create a network of studies on which statistical inference is based. When the network consists of a mixture of direct and indirect evidence with comparable studies and patient characteristics, the relative treatment effect of drug B vs. drug C may be indirectly estimated by comparing studies of drug A vs. drug B and drug A vs. drug C (dbc = dac _ dab) [10], [11]. The value of a network meta-analysis is that it can include both direct and indirect evidence, and it preserves the strength of randomization within individual RCTs. However, the method has limitations as it is based on a model simulation, and the method could result in biased estimates, if there are systematic differences across comparisons.

Methods

2.1 Search strategy

We searched MEDLINE, EMBASE, CNKI, PubMed, The Cochrane Central Register of Controlled Trials and The Cochrane Library prior to April 2013. The authors were contacted for further information regarding unpublished trials and reports found in published databases. Search terms included MeSH: acute ischemic stroke, AIS AND Edaravone OR Sodium ozagrel OR edaravone combined with Kininogenase OR Sodium ozagrel combined with edaravone AND randomized controlled trial (RCT). We also identified studies through manual searches of article references. No search limits were applied. Table S1 describes the literature search methods and restrictions applied to our search. We evaluated comparability of effect modifiers and potential heterogeneity between studies by...

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Gale Document Number: GALE|A478805773