Citicoline for the Management of Patients with Traumatic Brain Injury in the Acute Phase: A Systematic Review and Meta-Analysis
Background: Citicoline or CDP-choline is a neuroprotective/neurorestorative drug used in several countries for the treatment of traumatic brain injury (TBI). Since the publication of the controversial COBRIT, the use of citicoline has been questioned in this indication, so it was considered necessar...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-01-01
|
| Series: | Life |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-1729/13/2/369 |
| _version_ | 1827756796796731392 |
|---|---|
| author | Julio José Secades Helmut Trimmel Byron Salazar José Antonio González |
| author_facet | Julio José Secades Helmut Trimmel Byron Salazar José Antonio González |
| author_sort | Julio José Secades |
| collection | DOAJ |
| description | Background: Citicoline or CDP-choline is a neuroprotective/neurorestorative drug used in several countries for the treatment of traumatic brain injury (TBI). Since the publication of the controversial COBRIT, the use of citicoline has been questioned in this indication, so it was considered necessary to undertake a systematic review and meta-analysis to evaluate whether citicoline is effective in the treatment of patients with TBI. Methods: A systematic search was performed on OVID-Medline, EMBASE, Google Scholar, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and Ferrer databases, from inception to January 2021, to identify all published, unconfounded, comparative clinical trials of citicoline in the acute phase of head-injured patients— that is, treatment started during the first 24 h. We selected studies on complicated mild, moderate, and severe head-injured patients according to the score of the Glasgow Coma Scale (GCS). The primary efficacy measure was independence at the end of the scheduled clinical trial follow-up. Results: In total, 11 clinical studies enrolling 2771 patients were identified by the end. Under the random-effects model, treatment with citicoline was associated with a significantly higher rate of independence (RR, 1.18; 95% CI = 1.05–1.33; I2, 42.6%). The dose of citicoline or the administration route had no effect on outcomes. Additionally, no significant effects on mortality were found, and no safety concerns were noticed. Conclusions: This meta-analysis indicates some beneficial effects of citicoline’s increasing the number of independent patients with TBI. The most important limitation of our meta-analysis was the presumed heterogeneity of the studies included. Registration: PROSPERO CRD42021238998 |
| first_indexed | 2024-03-11T08:32:19Z |
| format | Article |
| id | doaj.art-3f19a9d7639f44a2a3e8e242a4c6eac6 |
| institution | Directory Open Access Journal |
| issn | 2075-1729 |
| language | English |
| last_indexed | 2024-03-11T08:32:19Z |
| publishDate | 2023-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Life |
| spelling | doaj.art-3f19a9d7639f44a2a3e8e242a4c6eac62023-11-16T21:40:19ZengMDPI AGLife2075-17292023-01-0113236910.3390/life13020369Citicoline for the Management of Patients with Traumatic Brain Injury in the Acute Phase: A Systematic Review and Meta-AnalysisJulio José Secades0Helmut Trimmel1Byron Salazar2José Antonio González3Medical Department, Ferrer, 08029 Barcelona, SpainDepartment of Anaesthesiology, Emergency Medicine and Critical Care, General Hospital of Wiener Neustadt, 2700 Wiener Neustadt, AustriaDepartment of Neurosurgery, Hospital Militar de Quito, Quito 170102, EcuadorStatistics and Operations Research Department, UPC, Barcelona-Tech, 08034 Barcelona, SpainBackground: Citicoline or CDP-choline is a neuroprotective/neurorestorative drug used in several countries for the treatment of traumatic brain injury (TBI). Since the publication of the controversial COBRIT, the use of citicoline has been questioned in this indication, so it was considered necessary to undertake a systematic review and meta-analysis to evaluate whether citicoline is effective in the treatment of patients with TBI. Methods: A systematic search was performed on OVID-Medline, EMBASE, Google Scholar, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and Ferrer databases, from inception to January 2021, to identify all published, unconfounded, comparative clinical trials of citicoline in the acute phase of head-injured patients— that is, treatment started during the first 24 h. We selected studies on complicated mild, moderate, and severe head-injured patients according to the score of the Glasgow Coma Scale (GCS). The primary efficacy measure was independence at the end of the scheduled clinical trial follow-up. Results: In total, 11 clinical studies enrolling 2771 patients were identified by the end. Under the random-effects model, treatment with citicoline was associated with a significantly higher rate of independence (RR, 1.18; 95% CI = 1.05–1.33; I2, 42.6%). The dose of citicoline or the administration route had no effect on outcomes. Additionally, no significant effects on mortality were found, and no safety concerns were noticed. Conclusions: This meta-analysis indicates some beneficial effects of citicoline’s increasing the number of independent patients with TBI. The most important limitation of our meta-analysis was the presumed heterogeneity of the studies included. Registration: PROSPERO CRD42021238998https://www.mdpi.com/2075-1729/13/2/369CDP-cholineciticolinemanagementtraumatic brain injuryneuroprotectionmeta-analysis |
| spellingShingle | Julio José Secades Helmut Trimmel Byron Salazar José Antonio González Citicoline for the Management of Patients with Traumatic Brain Injury in the Acute Phase: A Systematic Review and Meta-Analysis Life CDP-choline citicoline management traumatic brain injury neuroprotection meta-analysis |
| title | Citicoline for the Management of Patients with Traumatic Brain Injury in the Acute Phase: A Systematic Review and Meta-Analysis |
| title_full | Citicoline for the Management of Patients with Traumatic Brain Injury in the Acute Phase: A Systematic Review and Meta-Analysis |
| title_fullStr | Citicoline for the Management of Patients with Traumatic Brain Injury in the Acute Phase: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Citicoline for the Management of Patients with Traumatic Brain Injury in the Acute Phase: A Systematic Review and Meta-Analysis |
| title_short | Citicoline for the Management of Patients with Traumatic Brain Injury in the Acute Phase: A Systematic Review and Meta-Analysis |
| title_sort | citicoline for the management of patients with traumatic brain injury in the acute phase a systematic review and meta analysis |
| topic | CDP-choline citicoline management traumatic brain injury neuroprotection meta-analysis |
| url | https://www.mdpi.com/2075-1729/13/2/369 |
| work_keys_str_mv | AT juliojosesecades citicolineforthemanagementofpatientswithtraumaticbraininjuryintheacutephaseasystematicreviewandmetaanalysis AT helmuttrimmel citicolineforthemanagementofpatientswithtraumaticbraininjuryintheacutephaseasystematicreviewandmetaanalysis AT byronsalazar citicolineforthemanagementofpatientswithtraumaticbraininjuryintheacutephaseasystematicreviewandmetaanalysis AT joseantoniogonzalez citicolineforthemanagementofpatientswithtraumaticbraininjuryintheacutephaseasystematicreviewandmetaanalysis |