Efficacy and safety of amantadine for functional recovery in adults with traumatic brain injuries: A comprehensive systematic review and meta-analysis

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-07-28 DOI:10.1016/j.clineuro.2025.109084

Davi Orli Machado Grüdtner , João Padula Rocha , Mateus Damiani Monteiro , Josete Mazon , Giuliano Schmidt Bertazzo Silveira , Andrei Koerbel

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Abstract

Background

Amantadine is a dopaminergic agonist with neuroprotective and neurostimulant properties. Growing evidence about amantadine’s potential role for functional recovery in patients with Traumatic Brain Injury (TBI) was delivered by experimental and observational studies. Hence, this meta-analysis aimed to assess the efficacy and safety of amantadine in adults who suffered a TBI.

Methods

We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science until June 2024. The outcomes were Glasgow Coma Scale (GCS), Disability Rating Scale (DRS), total mortality, seizures, and gastrointestinal adverse events. We performed statistical analysis through R software (version 4.4.0). I² was used to assess heterogeneity.

Results

Our analyses included 10 studies, accounting for a total of 1182 patients. The doses ranged from 87.5 to 400 mg/day, and the phase when amantadine was administered varied from the acute phase to 6 months after the TBI. Amantadine showed no significant advantage in the pooled analysis for functional recovery [SMD −0.07; 95 % CI (−0.45, 0.31); p = 0.720; I² = 77.9 %]. The analysis of the RCTs subgroup found no difference between groups [SMD −0.37; 95 % CI (−0.82, 0.08); p = 0.107; I² = 67 %]. In a sensitivity analysis of the RCTs that assessed amantadine's effects in the first 6 weeks of treatment, a significant difference was found favoring amantadine [SMD −0.52; 95 % CI (−0.91, −0.13); p = 0.009; I² = 55 %]. Safety analysis showed no difference for total mortality [RR 0.77; 95 % CI (0.28, 2.17); p = 0.627; I² = 53 %].

Conclusions

Amantadine might be an adjuvant to standard care for adults with TBI, but further randomized research is required regarding its effects in the short and long-term periods.

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金刚烷胺用于成人外伤性脑损伤功能恢复的有效性和安全性：一项全面的系统回顾和荟萃分析

金刚烷胺是一种多巴胺能激动剂，具有神经保护和神经兴奋的特性。越来越多的证据表明金刚烷胺在创伤性脑损伤（TBI）患者功能恢复中的潜在作用是由实验和观察研究提供的。因此，本荟萃分析旨在评估金刚烷胺在成人TBI患者中的疗效和安全性。方法检索PubMed、EMBASE、Cochrane Central Register of Controlled Trials和Web of Science，检索时间截止到2024年6月。结果是格拉斯哥昏迷量表（GCS）、残疾评定量表（DRS）、总死亡率、癫痫发作和胃肠道不良事件。我们通过R软件（版本4.4.0）进行统计分析。I²用于评估异质性。结果纳入10项研究，共纳入1182例患者。剂量范围从87.5到400 mg/天，金刚烷胺的使用阶段从急性期到TBI后6个月不等。金刚烷胺在功能恢复的汇总分析中没有显着优势[SMD - 0.07；95 % ci (- 0.45, 0.31)；p = 0.720;²= 77.9  %)。rct亚组分析发现各组间无差异[SMD - 0.37；95 % ci (- 0.82, 0.08)；p = 0.107;²= 67 %]。在一项评估金刚烷胺治疗前6周疗效的随机对照试验的敏感性分析中，发现金刚烷胺的疗效有显著差异[SMD - 0.52；95 % ci (- 0.91, - 0.13)；p = 0.009;²= 55 %)。安全性分析显示总死亡率无差异[RR 0.77；95 % ci (0.28, 2.17)；p = 0.627;²= 53 %)。结论金刚烷定可能是成人TBI患者标准治疗的辅助药物，但其短期和长期疗效有待进一步的随机研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.