Tenecteplase outperforms alteplase in stroke recovery, offering superior outcomes in reducing disability and enhancing recovery quality.
People with ischemic strokes, the most common type caused by a blockage of blood flow to the brain, may benefit more from the drug tenecteplase compared to alteplase. A meta-analysis published in the October 16, 2024, online issue of Neurology, the medical journal of the American Academy of Neurology, suggests that tenecteplase increases the chances of an excellent recovery and decreases disability three months after a stroke better than alteplase, though both drugs offer similar chances of a good recovery.
Currently, alteplase is the only clot-busting drug approved by the U.S. Food and Drug Administration (FDA) for treating ischemic strokes. Tenecteplase, although newer and not FDA-approved for ischemic strokes in the U.S., is approved for this use in Europe. In the U.S., it is officially approved for treating clots in coronary arteries but is also used off-label at some stroke centers for ischemic strokes.
Study Insights on Tenecteplase vs. Alteplase
“When a person has an ischemic stroke, they may be treated with either tenecteplase or alteplase,” said study author Georgios Tsivgoulis MD, PhD, MSc, of the National and Kapodistrian University of Athens in Greece and a Fellow of the American Academy of Neurology. “While treatment with either drug increases the chances of a good recovery after stroke, we found people who were given tenecteplase were more likely to have an excellent recovery.”
For the meta-analysis, researchers reviewed 11 studies that compared the safety and efficacy of treatment with tenecteplase or alteplase within four-and-a-half hours after having a stroke. In those studies, 3,788 people were treated with tenecteplase, and 3,757 people were treated with alteplase.
Comparing Recovery Outcomes With Tenecteplase and Alteplase
Researchers examined participants’ recovery after three months. They used a scale with a score of zero to six where zero represents no symptoms and six represents death. An excellent recovery was defined as a score of zero to one where one represents no significant disability despite some symptoms. A good recovery was defined as a score of zero to two where two represents slight disability when someone is unable to do all previous tasks but can take care of themselves without help. Reduced disability was defined as a drop of one point or more on the scale at three months.
Researchers found people who were given tenecteplase had a 5% higher likelihood of excellent recovery than people who were given alteplase, as well as a 10% higher likelihood of reduced disability three months after stroke. The chances of a good recovery were similar for both groups.
Concluding Remarks on Stroke Recovery Drugs
“Our meta-analysis shows that while both drugs have similar safety and increase the chances of good recovery after stroke, tenecteplase is superior to alteplase with a greater chance of excellent recovery and reduced disability,” said Tsivgoulis. “Our findings support using tenecteplase over alteplase when treating people for ischemic stroke.”
A limitation of the meta-analysis was that while it looked at all available randomized-controlled clinical trials on tenecteplase and alteplase, three of the 11 studies were presented at scientific conferences but not yet published in a scientific journal.
Reference: “Tenecteplase vs Alteplase in Acute Ischemic Stroke Within 4.5 HoursA Systematic Review and Meta-Analysis of Randomized Trials” by Lina Palaiodimou, Aristeidis H. Katsanos, Guillaume Turc, Alexandros-Georgios Asimakopoulos, Dimitrios Mavridis, Peter D. Schellinger, Aikaterini Theodorou, Robin Lemmens, Simona Sacco, Apostolos Safouris, Mira Katan, Amrou Sarraj, Urs Fischer and Georgios Tsivgoulis, 16 October 2024, Neurology.
DOI: 10.1212/WNL.0000000000209903
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