Desmoteplase for Acute Ischemic Stroke: A Systematic Review and Meta-analysis of RCTs

Abstract

Introduction: There is an unmet need to develop better treatments for acute ischemic stroke (AIS). Desmoteplase is a vampire bat saliva-derived analogue of human tissue plasminogen activator. It has higher fibrin selectivity and a longer half-life, compared to alteplase. We performed this meta-analysis to synthesize evidence from published RCTs about the safety and efficacy of desmoteplase in AIS. Methods: A computer literature search for (PubMed, EMBASE, CENTRAL, Scopus, Web of science, and clinicaltrials.gov) was carried out. Data were extracted from eligible records and analyzed by RevMan software (version 5.3 for windows). Safety and efficacy endpoints were pooled as odds ratios for the two groups. Result: Five RCTs (n=821 patients) were pooled in the final analysis. The overall effect size favored desmoteplase over placebo in terms of reperfusion 4 to 24 hours posttreatment (OR 1.49, 95%CI [1.02, 2.19]). However, the pooled effect size did not significantly favor either of the two groups in terms of good clinical outcome at 90 days (OR 1.16, 95%CI [0.86, 1.55]). In terms of safety, neither of the primary safety outcomes differed significantly between the two groups; (symptomatic intracranial hemorrhage: OR 1.29, 95%CI [0.53, 3.16] and mortality within 90 days: OR 1.20, 95%CI [0.73, 1.97]). Conclusion: Current evidence suggests a favorable reperfusion effect for desmoteplase within 3 to 9 hours after AIS. Further large RCTs, particularly using a moderate dose between 90 µg/kg and 125 µg/kg are needed to translate this successful reperfusion into better clinical outcome and better quality of life for AIS patients.

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