Comprehensive evaluation of intravenous thrombolysis regimens for ischemic stroke based on network meta-analysis and cost-utility analysis
- VernacularTitle:基于网状Meta分析与成本-效用分析的缺血性卒中静脉溶栓方案综合评价
- Author:
Guochao YE
1
;
Shuai LIU
1
;
Yongbang CHEN
2
;
Yu SUN
3
;
Youqing TANG
1
Author Information
1. Dept. of Emergency，The Affiliated Guangdong Second Provincial General Hospital of Jinan University，Guangzhou 510317，China
2. Dept. of Pharmacy，The First Affiliated Hospital of Guangzhou Medical University，Guangzhou 510120，China
3. Dept. of Cardiac Intensive Care Unit，The Affiliated Guangdong Second Provincial General Hospital of Jinan University，Guangzhou 510317，China
- Publication Type:Journal Article
- Keywords:
Ischemic stroke;
Intravenous thrombolysis;
Alteplase;
tenecteplase;
Reteplase;
recombinant human prourokinase;
Network Meta-analysis;
Pharmacoeconomics
- From:
China Pharmacy
2026;37(19):2589-2596
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To evaluate the differences in efficacy， safety， and cost-effectiveness among multiple dosing regimens of four intravenous thrombolytic agents [alteplase （rt-PA）， tenecteplase （TNK）， reteplase （rPA）， and recombinant human prourokinase （rhPro-UK）] in the treatment of ischemic stroke.METHODS Randomized controlled trials （RCTs） of the above agents for intravenous thrombolysis in ischemic stroke were searched. Network meta-analysis （NMA） was performed to compare the efficacy and safety of different regimens， and a Markov model was constructed to evaluate cost-effectiveness from the perspective of the Chinese healthcare system.RESULTS Twenty RCTs involving 10 regimens were included. NMA showed that the 18 mg+18 mg rPA regimen （two intravenous boluses of 18 mg rPA） was superior to all TNK regimens （0.1， 0.25， and 0.4 mg/kg）， all rt-PA regimens （0.6 and 0.9 mg/kg）， and the 35 mg rhPro-UK regimen in terms of excellent functional outcome； the 0.25 mg/kg TNK regimen was superior to the 0.6 and 0.9 mg/kg rt-PA regimens. In terms of good functional outcome， the 18 mg+18 mg rPA regimen was superior to the 0.25 and 0.4 mg/kg TNK regimens， the 0.6 and 0.9 mg/kg rt-PA regimens， and the 35 mg rhPro-UK regimen； the 0.25 mg/kg TNK regimen was superior to the 0.4 mg/kg TNK regimen. The 18 mg+18 mg rPA regimen had the lowest incidence of poor functional outcome. In terms of avoiding extremely poor functional outcomes， the 0.6 mg/kg rt-PA regimen was the best， and the 0.4 mg/kg TNK regimen was the worst. In terms of safety， the incidence of symptomatic intracerebral hemorrhage （sICH） with the 35 mg rhPro-UK regimen was significantly lower than that with the 12 mg+12 mg rPA regimen （two intravenous boluses of 12 mg rPA） and the 0.4 mg/kg TNK regimen； the sICH incidences with the 0.25 mg/kg TNK regimen and the 0.6 and 0.9 mg/kg rt-PA regimens were significantly lower than that with the 0.4 mg/kg TNK regimen， and the 0.6 mg/kg rt-PA regimen was superior to the 0.9 mg/kg rt-PA regimen. Cost-utility analysis showed that， at a willingness-to-pay threshold of twice the 2025 national per capita gross domestic product， the 18 mg+18 mg rPA regimen had the greatest cost-effectiveness advantage； sensitivity analysis confirmed that the base-case results were robust； in both scenario analyses， the probability that this regimen was cost-effective was 100%.CONCLUSIONS Among the 10 intravenous thrombolysis regimens for ischemic stroke， the 18 mg+18 mg rPA regimen was the optimal regimen combining efficacy and cost-effectiveness； the 35 mg rhPro-UK regimen may be the preferred option for patients at high bleeding risk.
