Edaravone For Subarachnoid Hemorrhage: A Systematic Review Of Randomized Controlled Trials

Objectives To evaluate the efficacy and safety of edaravone in subarachnoid hemorrhage. Methods The Cochrane systematic review method was used to evaluate the Randomized Controlled Trials (RCT) of Edaravone for SAH. The searching strategy included: MEDLINE(1966 to Nov. 2010), EMBASE (1984 to Nov.2010), The Cochrane Central Register of Controlled Trials(Issue 4, 2010), China Biological Medicine Database (CBM, 1979-2010.11), China Academic Journal (CNKI, 1979-2010.11), Chinese Science and Technology Periodical Database (VIP, 1979-2010.11) and digital full-text journal database (1979-2010.11). In addition, we tracked down the reference lists of papers related to edaravone. And we handsearched 4 important Chinese journals. Two reviewers independently selected studies, assessed quality of studies and extracted data. The RevMan 5.0 software was used for statistical analysis. Results We identified 12 completed RCTs, of which 10 trials (include 673 patients) met the inclusion criteria. Meta-analysis showed that edaravone was associated with reduction in the incidence of death and poor outcomes [OR = 0.32, 95% CI (0.14, 0.75), NNT = 15], [OR = 0.41, 95% CI (0.17,0.96), NNT = 12], suggesting that treatment of 15 patients would avoid one person suffering died and treatment of 12 patients would avoid one person suffering died. edaravone also can reduce the the incidence of cerebral vasospasm and ischemic stroke [OR = 0.28, 95% CI (0.16,0.50), NNT = 4], [ OR = 0.19, 95% CI (0.07,0.50) NNT = 10,], suggesting that treatment of 4 patients would avoid one person suffering vasospasm and treatment of 10 patients would avoid one person suffering ischemic stroke. However, none of the included trials described the method of randomization, the situation of allocation concealment was not clear, trials did not report blinding. Therefore, it is possible that all trials exist bias in the selection, implementation and measurement. So, These results should be cautious. three trials reported adverse reactions of edaravone, they are Rash and the abnormal of alanine aminotransferase, these were not statistically significant. Conclusions With relatively poor quality of most included trials, insufficient evidence is obtained to support the conclusion that the edaravone is safe or effective in the treatment of SAH. Further high quality randomized controlled trials should be carried out.