Survival in Amyotrophic Lateral Sclerosis Patients Treated with Edaravone – a Pooled Analysis of 2845 Patients
Anas Nourelden1, Ibrahim Kamal1, Abdelrahman G. Tawfik2, Mahmoud M. Elhady3, Abdulrahman Hagrass1, Ahmed Hashem Fathallah 4, Mohamed Zaazouee5
1Faculty of Medicine, Al-Azhar university, Cairo, Egypt, 2Department of Pharmacotherapy, College of Pharmacy, The University of Utah, Salt Lake City, UT, USA, 3Faculty of Medicine, Benha university, Qalubiya , Egypt, 4Faculty of Medicine, Minia University, Minia, Egypt., 5Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
Objective:
Since the evidence on the efficacy and safety of edaravone in the treatment of Amyotrophic Lateral Sclerosis (ALS) is still debatable, we conducted a systematic review and meta-analysis.
Background:
ALS as a neurodegenerative disorder is becoming more prevalent, with a higher incidence rate in all regions worldwide. High concentrations of reactive oxygen species and mitochondrial dysfunction are hallmarks of neurodegenerative disorders' pathogenesis. Edaravone was the first free-radical scavenger discovered, and it has been shown that it can preserve cells in both humans and animals.
Design/Methods:
We searched PubMed, Web of Science, Cochrane, Scopus, and Embase for relevant articles till October 2022. We included randomized controlled trials and cohort studies comparing edaravone plus riluzole or edaravone alone with riluzole or placebo as a control for ALS. In the case of continuous data, we used the mean difference (MD) with 95% CI, and in the case of dichotomous data, we used the risk ratio (RR) with 95% CI.
Results:
We pooled data from 12 studies involving 2845 participants. Of those patients, 1141 (40.1%) were given edaravone and 1704 (59.9%) were given the control. We detected a significant difference in survival rate at 18 months (RR=1.13, 95% CI [1.02, 1.24]), 24 months (RR=1.22, 95% CI [1.06, 1.41]), and 30 months (RR=1.17, 95% CI [1.01, 1.34]) but not at 6 months (RR=1.04, 95% CI [0.94, 1.14]) and 12 months (1.09, 95% CI [0.97, 1.23]). Our comparison found that edaravone therapy has no significant effect on the change in ALSFRS-R score (MD=1.14, 95% CI [-0.30, 2.58]). As regards adverse events, we didn't find any significant difference (RR=1.04, 95% CI [0.96, 1.13]).
Conclusions:
Edaravone treatment improves long-term survival with no effect on the ALSFRS-R score. Adverse events occurred at similar rates between the two groups.