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Aminosteroids for acute traumatic brain injury.
1Department of Epidemiology, Institute of Child Health, 30 Guilford Street, London, UK, WC1N 1EH. Ian.roberts@ich.ucl.ac.uk
The Cochrane Database of Systematic Reviews
|October 18, 2000
Summary
Aminosteroids show no significant benefit for traumatic brain injury (TBI) patients. Current evidence does not support their routine use, though further trials are pending.
Area of Science:
- Neuroscience
- Pharmacology
- Clinical Trials
Background:
- Traumatic brain injury (TBI) is a significant cause of mortality and disability.
- Post-traumatic lipid peroxidation is a proposed mechanism for secondary brain damage.
- Aminosteroids inhibit lipid peroxidation in animal models and may improve TBI outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of aminosteroids in treating acute traumatic brain injury.
- To synthesize evidence from randomized controlled trials on aminosteroid treatment for TBI.
Main Methods:
- Comprehensive literature search of Cochrane Injuries Group, Cochrane Controlled Trials Register, MEDLINE, and EMBASE.
- Inclusion of randomized controlled trials comparing aminosteroids to placebo for acute TBI.
- Independent review of search results and application of selection criteria by two reviewers.
Main Results:
- Two randomized controlled trials investigated the aminosteroid tirilazad mesylate for TBI.
- One trial's results indicate similar risks of death (RR=1.05) and death/severe disability (RR=1.07) between tirilazad and placebo groups.
- Data from a completed trial with 1156 participants is pending.
Conclusions:
- Existing evidence does not support the routine administration of aminosteroids for TBI.
- The possibility of moderate clinical benefits or harms from aminosteroids cannot be excluded.
- Further research, including results from a large completed trial, is needed to clarify the role of aminosteroids in TBI management.