Junpeng Ma, Siqing Huang, Lu Ma, Yi Liu, Hao Li, Chao You Critical Care 2012, 16:R198 (18 October 2012)
Introduction: Previous meta-analysis of the use of endothelin-receptor antagonists (ETRAs) to treat aneurysmal subarachnoid hemorrhage (SAH) has become outdated due to recently published Phase-3 clinical trials. An up-to-date meta-analysis is needed to provide the best available evidence of the efficacy of ETRAs for aneurysmal SAH.
Methods: We performed a systematic review and meta-analysis of published randomized controlled trials that investigate efficacy of ETRAs in patients with aneurysmal SAH. Mortality, unfavorable outcome, delayed ischaemic neurological deficit (DIND), delayed cerebral infarction (DCI), angiographic vasospasm and adverse events were analyzed. Meta-analysis was performed in terms of the risk ratio (RR) and 95% confidence interval (CI).
Results: Five eligible studies were reviewed and analyzed, involving 2595 patients. The pooled RR of mortality and unfavorable outcome after SAH were 1.03 (95%CI 0.77 to 1.36) and 1.07 (95%CI 0.93 to 1.22) respectively. The pooled RR were 0.87 (95%CI 0.74 to 1.03) for DCI, 0.77 (95%CI 0.66 to 0.90) for DIND, and 0.66 (95%CI 0.57 to 0.77) for angiographic vasospasm. There were significant increase in lung complications (RR 1.80, 95%CI 1.55 to 2.09), hypotension (RR 2.42, 95%CI 1.78 to 3.29) and anaemia (RR 1.47, 95%CI 1.19 to 1.83) in patients administrated ETRAs.
Conclusions: There is no evidence that ETRAs could provide benefit clinical outcome in patients with SAH. Due to the increased adverse events, further clinical trials of ETRAs in SAH patient should be more carefully formulated and designed. The present results also suggest that DCI may be a better outcome measure than vasospasm and DIND in SAH clinical trials and observational studies.
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