Tenecteplase vs. Alteplase for Intravenous Thrombolytic Therapy of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

IntroductionIn recent years, as one of the drugs for the treatment of acute ischemic stroke (AIS), the clinical application of tenecteplase is still controversial. Therefore, we aimed to evaluate the safety and efficacy of tenecteplase versus alteplase to guide clinical practice.MethodsA search of PubMed, MEDLINE, EMBASE, Cochrane Library, and Web of Science databases until February 15, 2023 was conducted to identify eligible articles. The quality of the included studies was assessed using the Cochrane Risk of Bias tool. RevMan 5.3 and Stata 17 were used to perform the meta-analysis and detect publication bias, and risk ratios (RRs) with 95% confidence intervals (95% CIs) were reported for each outcome measure.ResultsA total of 1326 records were retrieved in this meta-analysis. As a result of the limited reports on tenecteplase in patients with AIS and the lack of high-quality randomized controlled trials (RCTs), and considering the impact of publication bias, we did not include any of these studies published before 2015. Ultimately we included 16 RCTs with a total of 7508 patients, including 3940 patients treated with alteplase and 3568 patients treated with tenecteplase. Tenecteplase was associated with better early neurological improvement (RR 0.10; 95% CI 0.00-0.19; P = 0.04), recanalization of blood vessels (RR 0.24; 95% CI 0.07-0.40; P = 0.01), and 90-day excellent neurological recovery (RR 0.12; 95% CI 0.01-0.24; P = 0.04). In addition, there were no significant differences in other efficacy and safety outcomes between the two groups. The funnel plot and Begg's as well as Egger's tests showed no significant publication bias.ConclusionsThis meta-analysis showed that tenecteplase was not inferior to alteplase in early thrombolytic therapy in patients with AIS, and was even better than alteplase on some efficacy outcomes with no significant differences in safety. However, as a result of some inherent limitations of this study, more high-quality prospective clinical studies are needed to confirm these results. Plain Language SummaryIn recent years, there has been controversy surrounding the use of tenecteplase, a drug for treating acute ischemic stroke (AIS). To help doctors make better decisions, we compared the safety and effectiveness of tenecteplase with another drug called alteplase. We looked at various research articles from PubMed, MEDLINE, EMBASE, Cochrane Library, and Web of Science databases until February 15, 2023. After careful analysis, we found 16 relevant studies with a total of 7508 patients, including those treated with alteplase and tenecteplase. Our findings showed that tenecteplase was as effective as alteplase in providing early thrombolytic therapy for patients with AIS. In fact, tenecteplase even showed better results in some aspects of treatment, without compromising safety. However, we acknowledge some limitations in our study and recommend more high-quality clinical studies to validate these results.

Automated summary

This meta-analysis found that the clinical application of tenecteplase, one of the drugs for the treatment of acute ischemic stroke (AIS), is still controversial. However, compared to alteplase, tenecteplase is not inferior in terms of safety and efficacy in early thrombolytic therapy for AIS. In fact, tenecteplase showed better results in some efficacy outcomes without significant differences in safety. However, more high-quality prospective clinical studies are still needed to confirm these results.