The sodium-glutamate antagonist riluzole improves outcome after acute spinal cord injury: results from the RISCIS randomised controlled trial analysed using a global statistical analytic technique.

IF 10.8 1区 医学 Q1 MEDICINE, RESEARCH & EXPERIMENTAL
EBioMedicine Pub Date : 2025-08-01 Epub Date: 2025-07-24 DOI:10.1016/j.ebiom.2025.105863
Michael G Fehlings, Karlo M Pedro, Mohammed Ali Alvi, Ali Moghaddamjou, James S Harrop, Ralph Stanford, Jonathon Ball, Bizhan Aarabi, Paul M Arnold, James D Guest, Shekar N Kurpad, James M Schuster, Ahmad N Nassr, Karl M Schmitt, Jefferson R Wilson, Darrel S Brodke, Faiz U Ahmad, Albert Yee, Wilson Z Ray, Nathaniel P Brooks, Jason Wilson, Diana S-L Chow, Elizabeth G Toups, Kevin E Thorpe, Jiaxin Huang, Peng Huang
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引用次数: 0

Abstract

Background: Spinal cord injury (SCI) clinical trials typically rely on a single primary endpoint to assess drug efficacy. This strategy fails to adequately capture the full impact of treatment in heterogenous neurological conditions like SCI. A more patient-centric analysis requires assessment of neurological function, functional capacity, and quality of life, incorporating meaningful patient-reported outcomes. The global statistical test (GST) addresses this challenge using a unified statistical conclusion regarding the superiority of a treatment strategy over another by evaluating multiple trial endpoints simultaneously.

Methods: The RISCIS trial (Safety and Efficacy of Riluzole in Acute Spinal Cord Injury Study) data was analysed using a multivariate nonparametric GST, integrating the total American Spinal Injury Association (ASIA) motor score (TOTM), Spinal Cord Independence Measure (SCIM), and SF-36 PCS (Short Form-36 Physical Component Scale) scores. In the RISCIS trial, patients with severe cervical SCI (AIS A, B, and C) were randomised to receive riluzole or placebo within 12 h of injury in a double blinded fashion. We compared six-month outcomes between groups using a modified O'Brien's rank sum test with sample variance adjustment. Higher summed ranks represent better global outcomes. The overall probability of improvement was computed using a summary estimate, the global treatment effect (GTE).

Findings: A total of 131 patients (mean age 45.8 years old, 82% males) completed the six-month outcome assessment. Among these, 49.6% were classified as AIS A, 20.6% as AIS B, and 29% as AIS C. Riluzole was administered within 12 h from injury for 14 days in 65 patients, while 66 received a placebo. The unadjusted mean change from baseline to six months showed a favourable response in the riluzole group compared to placebo across TOTM (p = 0.28 by t-test; p = 0.26 by Wilcoxon test), SCIM (p = 0.04 by t-test; p = 0.02 by Wilcoxon test), or SF-36 PCS (p = 0.23 by t-test; p = 0.21 by Wilcoxon test) scores. Using the GST to simultaneously assess these measures, the riluzole group exhibited a higher rank sum compared to placebo [median rank sum = 207 (IQR: 166-246) in riluzole vs 185 (IQR: 146-236) in placebo, p = 0.04]. Subgroup analysis revealed the greatest treatment benefit among patients with AIS A injuries (GTE = 0.16, 95% CI: 0.01-0.31, p = 0.02). At six months, the probability that riluzole treatment resulted in overall better outcomes than placebo across all assessed outcomes was 58%.

Interpretation: Riluzole was associated with improved global outcomes in patients with severe traumatic SCI, based on a composite score integrating ASIA total motor scores, SCIM, and SF36 outcomes at six months. Riluzole is a promising therapeutic option in SCI, but further investigation through higher-quality studies incorporating multidimensional assessments is warranted.

Funding: No funding was received for the present work. The original clinical trial (NCT01597518) was funded by the AO Foundation, United States Department of Defense (DOD), and the Praxis Spinal Cord Institute.

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谷氨酸钠拮抗剂利鲁唑改善急性脊髓损伤后的预后:RISCIS随机对照试验的结果使用全球统计分析技术进行了分析。
背景:脊髓损伤(SCI)临床试验通常依赖单一主要终点来评估药物疗效。这一策略未能充分捕捉到治疗异质性神经系统疾病(如脊髓损伤)的全部影响。更以患者为中心的分析需要评估神经功能、功能能力和生活质量,并纳入有意义的患者报告结果。全球统计检验(GST)通过同时评估多个试验终点,使用关于治疗策略优于另一个治疗策略的统一统计结论来解决这一挑战。方法:RISCIS试验(利鲁唑在急性脊髓损伤研究中的安全性和有效性)数据使用多变量非参数GST进行分析,整合美国脊髓损伤协会(ASIA)运动评分(TOTM)、脊髓独立性测量(SCIM)和sf - 36pcs (Short Form-36 Physical Component Scale)评分。在RISCIS试验中,严重颈椎SCI患者(AIS A、B和C)在损伤后12小时内以双盲方式随机接受利鲁唑或安慰剂治疗。我们使用带有样本方差调整的修正O'Brien秩和检验比较两组间六个月的结果。综合排名越高,代表全球结果越好。总体改善的可能性是通过总体治疗效果(GTE)来计算的。结果:共有131例患者(平均年龄45.8岁,82%为男性)完成了为期6个月的结果评估。其中49.6%为AIS A, 20.6%为AIS B, 29%为AIS c。65例患者在损伤后12小时内给予利鲁唑,持续14天,66例患者给予安慰剂。从基线到6个月的未经调整的平均变化表明,与安慰剂相比,利鲁唑组在整个TOTM中有良好的反应(t检验p = 0.28;Wilcoxon检验p = 0.26), SCIM (t检验p = 0.04;Wilcoxon检验p = 0.02)或sf - 36pcs (t检验p = 0.23;Wilcoxon检验p = 0.21)分数。使用GST同时评估这些措施,利鲁唑组与安慰剂组相比表现出更高的秩和[中位秩和= 207 (IQR: 166-246) vs安慰剂组185 (IQR: 146-236), p = 0.04]。亚组分析显示,AIS A损伤患者的治疗获益最大(GTE = 0.16, 95% CI: 0.01-0.31, p = 0.02)。在6个月时,利鲁唑治疗在所有评估结果中导致总体结果优于安慰剂的概率为58%。解释:根据亚洲总运动评分、SCIM和6个月时SF36结果的综合评分,利鲁唑与严重创伤性脊髓损伤患者的整体预后改善有关。利鲁唑是一种很有前景的脊髓损伤治疗选择,但需要通过包含多维评估的高质量研究进行进一步的研究。经费:没有收到本工作的经费。最初的临床试验(NCT01597518)由AO基金会、美国国防部(DOD)和Praxis脊髓研究所资助。
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来源期刊
EBioMedicine
EBioMedicine Biochemistry, Genetics and Molecular Biology-General Biochemistry,Genetics and Molecular Biology
CiteScore
17.70
自引率
0.90%
发文量
579
审稿时长
5 weeks
期刊介绍: eBioMedicine is a comprehensive biomedical research journal that covers a wide range of studies that are relevant to human health. Our focus is on original research that explores the fundamental factors influencing human health and disease, including the discovery of new therapeutic targets and treatments, the identification of biomarkers and diagnostic tools, and the investigation and modification of disease pathways and mechanisms. We welcome studies from any biomedical discipline that contribute to our understanding of disease and aim to improve human health.
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