Effectiveness comparisons of drug therapies for postoperative aneurysmal subarachnoid hemorrhage patients: network meta?analysis and systematic review


Abstract

Objective: To compare the effectiveness of various drug interventions in improving the clinical outcome of postoperative patients after aneurysmal subarachnoid hemorrhage (aSAH) and assist in determining the drugs of definite curative effect in improving clinical prognosis.

Methods: Eligible Randomized Controlled Trials (RCTs) were searched in databases of PubMed, EMBASE, and Cochrane Library (inception to Sep 2020). Glasgow Outcome Scale (GOS) score, Extended Glasgow Outcome Scale (GOSE) score or modified Rankin Scale (mRS) score was used as the main outcome measurements to evaluate the efficacy of various drugs in improving the clinical outcomes of postoperative patients with aSAH. The network meta-analysis (NMA) was conducted based on a random-effects model, dichotomous variables were determined by using odds ratio (OR) with 95% confidence interval (CI), and a surface under the cumulative ranking curve (SUCRA) was generated to estimate the ranking probability of comparative effectiveness among different drug therapies.

Results: From the 493 of initial citation screening, forty-four RCTs (n = 10,626 participants) were eventually included in our analysis. Our NMA results showed that cilostazol (OR = 3.35,95%CI = 1.50,7.51) was the best intervention to improve the clinical outcome of patients (SUCRA = 87.29%, 95%CrI 0.07-0.46). Compared with the placebo group, only two drug interventions [nimodipine (OR = 1.61, 95%CI 1.01,2.57) and cilostazol (OR = 3.35, 95%CI 1.50, 7.51)] achieved significant statistical significance in improving the clinical outcome of patients.

Conclusions: Both nimodipine and cilostazol have exact curative effect to improve the outcome of postoperative patients with aSAH, and cilostazol may be the best drug to improve the outcome of patients after aSAH operation. Our study provides implications for future studies that, the combination of two or more drugs with relative safety and potential benefits (e.g., nimodipine and cilostazol) may improve the clinical outcome of patients more effectively.

Keywords: Aneurysmal subarachnoid hemorrhage; Clinical outcome; Drug therapies; Network meta-analysis.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
legend Literature screening flowchart. NID nimodipine, MGS magnesium, CTZ cilostazol, CST clazosentan, FSD fasudil, NCD nicardipine, TZD tirilazad, ENP Enoxaparin, EPO erythropoietin, MPN methylprednisolone, ST statins, rt-PA Recombinant Human Tissue-type plasminogen activator, ω-3FA Omega-3 fatty acid
Fig. 2
Fig. 2
legend Network of evidence of the included trials
Fig. 3
Fig. 3
legend Relative effect sizes of efficacy at post-treatment according to network meta-analysis. Treatments are ranked according to their chance of being the best treatment. Numbers in the gray boxes are the values of SUCRA (the surface under the cumulative ranking curve), which represents the rank of treatment. Significant pairwise comparisons are highlighted in orange. In terms of post-treatment efficacy, patients with OR (odds ratio) less than 1 favor the designated control group (DCG)
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