Buflomedil for acute ischaemic stroke

Area of Science:

• Neurology
• Pharmacology

Background:

• Few effective treatments exist for acute ischemic stroke.
• Buflomedil, a vasoactive agent, shows potential for cerebrovascular diseases.
• Buflomedil is not currently approved for clinical stroke treatment.

Purpose of the Study:

• To evaluate the efficacy and safety of buflomedil for acute ischemic stroke.
• To synthesize evidence from randomized controlled trials (RCTs) on buflomedil's use in stroke patients.

Main Methods:

• Comprehensive search of multiple databases including Cochrane, MEDLINE, EMBASE, and Chinese databases.
• Inclusion of 26 RCTs (2756 participants) comparing buflomedil with placebo or usual care.
• Primary outcome: long-term death or disability. Secondary outcomes: short-term death, disability, neurological deficits, and adverse events.
• Meta-analysis for death and neurological deficits; narrative reporting for disability and adverse events.
• Subgroup analyses based on time since stroke, delivery route, dose, and duration.

Main Results:

• All included trials were conducted in China, with participants being inpatients within days of stroke onset.
• One trial indicated a potential reduction in death or disability with buflomedil (RR 0.71, 95% CI 0.53 to 0.94), but evidence quality was low.
• No robust evidence was found for short-term outcomes (death, disability, neurological deficits).
• Adverse events were reported in 11 trials (1046 participants), with 38 events in the buflomedil group versus two in the control group.
• Overall evidence quality for all outcomes was low according to GRADE principles.

Conclusions:

• Insufficient evidence currently supports the use of buflomedil for acute ischemic stroke treatment.
• The findings highlight the need for adequately powered randomized controlled trials.
• Further research is warranted to definitively establish buflomedil's efficacy and safety profile.