Cerebrolysin after moderate to severe traumatic brain injury: prospective meta-analysis of the CAPTAIN trial series

• Published in: Neurological sciences 2021-11, Vol.42 (11), p.4531-4541
• Main Authors: Vester, Johannes C., Buzoianu, Anca D., Florian, Stefan I., Hömberg, Volker, Kim, Se-Hyuk, Lee, Tatia M. C., Matula, Christian, Poon, Wai Sang, Sandesc, Dorel, von Steinbüchel, Nicole, Strilciuc, Stefan, Vos, Pieter E., von Wild, Klaus, Muresanu, Dafin
• Format: Article
• Language: English
• Subjects: Amino Acids - therapeutic use; Brain Injuries, Traumatic - drug therapy; Clinical trials; Clinical Trials, Phase III as Topic; Double-blind studies; Humans; Medicine; Medicine & Public Health; Meta-analysis; Middle Aged; Neurology; Neuroprotective Agents - therapeutic use; Neuroradiology; Neurosciences; Neurosurgery; Original Article; Patients; Placebos; Prospective Studies; Psychiatry; Randomized Controlled Trials as Topic; Statistical analysis; Systematic review; Traumatic brain injury; Treatment Outcome
• ISSN: 1590-1874; 1590-3478; 1590-3478
• DOI: 10.1007/s10072-020-04974-6

Introduction This prospective meta-analysis summarizes results from the CAPTAIN trial series, evaluating the effects of Cerebrolysin for moderate-severe traumatic brain injury, as an add-on to usual care. Materials and methods The study included two phase IIIb/IV prospective, randomized, double-blind, placebo-controlled clinical trials. Eligible patients with a Glasgow Coma Score (GCS) between 6 and 12 received study medication (50 mL of Cerebrolysin or physiological saline solution per day for ten days, followed by two additional treatment cycles with 10 mL per day for 10 days) in addition to usual care. The meta-analysis comprises the primary ensembles of efficacy criteria for 90, 30, and 10 days after TBI with a priori ordered hypotheses based on multivariate, directional tests. Results A total 185 patients underwent meta-analysis (mean admission GCS = 10.3, mean age = 45.3, and mean Baseline Prognostic Risk Score = 2.8). The primary endpoint, a multidimensional ensemble of functional and neuropsychological outcome scales indicated a “small-to-medium” sized effect in favor of Cerebrolysin, statistically significant at Day 30 and at Day 90 (Day 30: MW combined  = 0.60, 95%CI 0.52 to 0.66, p  = 0.0156; SMD = 0.31; OR = 1.69; Day 90: MW combined  = 0.60, 95%CI 0.52 to 0.68, p  = 0.0146; SMD = 0.34, OR = 1.77). Treatment groups showed comparable safety and tolerability profiles. Discussion The meta-analysis of the CAPTAIN trials confirms the safety and efficacy of Cerebrolysin after moderate-severe TBI, opening a new horizon for neurorecovery in this field. Integration of Cerebrolysin into existing guidelines should be considered after careful review of internationally applicable criteria.