Emerging pharmacological agents to improve survival from traumatic brain injury

Radosevich, John; Patanwala, Asad E.; Erstad, Brian L.

doi:10.3109/02699052.2013.823658

Cited by 13 publications

(13 citation statements)

References 29 publications

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“…(29–33) Four were excluded as they were case series or case reports (34–37). Seven were excluded as they were review articles (2,38–43). Three were excluded as they were studies in animals (44–46).…”

Section: Resultsmentioning

confidence: 99%

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Beta-blockers and Traumatic Brain Injury

et al. 2017

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OBJECTIVE To determine if beta-(β)-blockers improve outcomes after acute traumatic brain injury (TBI). BACKGROUND There have been no new inpatient pharmacologic therapies to improve TBI outcomes in a half-century. Treatment of TBI patients with β-blockers offers a potentially beneficial approach. METHODS Using MEDLINE, EMBASE, and CENTRAL databases, eligible articles for our systematic review and meta-analysis (PROSPERO CRD42016048547) included adult (age≥16 years) blunt trauma patients admitted with TBI. The exposure of interest was β-blocker administration initiated during the hospitalization. Outcomes were mortality, functional measures, quality of life, cardiopulmonary morbidity (e.g. hypotension, bradycardia, bronchospasm, and/or congestive heart failure). Data were analyzed using a random-effects model, and represented by pooled odds ratio (OR) with 95% confidence intervals (CI) and statistical heterogeneity (I2). RESULTS Data were extracted from 9 included studies encompassing 2005 unique TBI patients with β-blocker treatment and 6240 unique controls. Exposure to β-blockers after TBI was associated with a reduction of in-hospital mortality (pooled OR 0.39, 95%CI: 0.27–0.56; I2=65%, p<0.00001). None of the included studies examined functional outcome or quality of life measures, and cardiopulmonary adverse events were rarely reported. No clear evidence of reporting bias was identified. CONCLUSIONS In adults with acute TBI, observational studies reveal a significant mortality advantage with β-blockers; however, quality of evidence is very low. We conditionally recommend the use of in-hospital β-blockers. However, we recommend further high-quality trials to answer questions about the mechanisms of action, effectiveness on subgroups, dose-response, length of therapy, functional outcome, and quality of life after β-blocker use for TBI.

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Section: Resultsmentioning

confidence: 99%

“…Treatment with beta-adrenergic receptor antagonists offers a potentially beneficial approach to blunting this cascade of sympathetic activation after TBI (3,5). However, β-blockers are negative inotropes and can induce bradycardia.…”

Section: Introductionmentioning

confidence: 99%

Beta-blockers and Traumatic Brain Injury

et al. 2017

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“…This anti-platelet activity may be the result of reduction in platelet membrane cholesterol content [92]. There is considerable evidence to suggest that statins have further mechanism of action that may modify brain injury before [93], during, and after cerebral ischemia with effects on nitric oxide formation [94,95], anti-inflammatory effects [96], antioxidant effects [97,98] and neuronal protection [99].…”

Section: Mechanisms Of Actionmentioning

confidence: 99%

Statins in neurological disorders: An overview and update

Malfitano

Marasco

Proto

et al. 2014

Pharmacological Research

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“…When tested in a variety of animal models of TBI and stroke, erythropoietin has anti-apoptotic, anti-oxidative, angiogenic, and neurotrophic activities (Radosevich et al, 2013; Sargin et al, 2010). Fewer studies have examined anti-inflammatory activity of erythropoietin.…”

Section: Introductionmentioning

confidence: 99%

Treatment of traumatic brain injury with anti-inflammatory drugs

Bergold

2016

Experimental Neurology

135

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Traumatic brain injury rapidly induces inflammation. This inflammation is produced both by endogenous brain cells and circulating inflammatory cells that enter from the brain. Together they drive the inflammatory response through a wide variety of bioactive lipids, cytokines and chemokines. A large number of drugs with antiinflammatory action have been tested in both preclinical studies and in clinical trials. These drugs either have known anti-inflammatory action or inhibit the inflammatory response through unknown mechanisms. The results of these preclinical studies and clinical trials are reviewed. Recommendations are suggested on how to improve preclinical testing of drugs to make them more relevant to evaluate for clinical trials.

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Emerging pharmacological agents to improve survival from traumatic brain injury

Cited by 13 publications

References 29 publications

Beta-blockers and Traumatic Brain Injury

Beta-blockers and Traumatic Brain Injury

Statins in neurological disorders: An overview and update

Treatment of traumatic brain injury with anti-inflammatory drugs

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