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Review article

Safety and efficacy of recovery-promoting drugs for motor function after stroke: A systematic review of randomised controlled trials

Nerida Firth, Ruth N. Barker, Kathryn S. Hayward, Julie Bernhardt, Michelle Bellingan, Ronny Gunnarsson


DOI: 10.2340/16501977-2536

Abstract

Objective: To investigate the efficacy and safety of drug interventions to promote motor recovery post-stroke.
Data sources: CENTRAL, CINAHL, Embase, MEDLINE, SCOPUS and Web of Science.
Study selection: Published human randomized controlled trials in which the primary intervention was a drug administered to promote motor recovery post-stroke, vs placebo.
Data extraction: Standardized pro forma used to extract safety and efficacy data; Cochrane Collaboration risk of bias assessment tool performed to assess risk of bias.
Data synthesis: Fifty randomized controlled trials from 4,779 citations were included. An overall trend of high risk of attrition (n = 27) and reporting bias (n = 36) was observed. Twenty-eight different drug interventions were investigated, 18 of which demonstrated statistically significant results favouring increased motor recovery compared with control intervention. Forty-four studies measured safety; no major safety concerns were reported.
Conclusion: Candidate drug interventions promoting motor recovery post-stroke were identified, specifically selective serotonin reuptake inhibitors and levodopa; however, the high risk of bias in many trials is concerning. Drugs to improve motor function remain an important area of enquiry. Future research must focus on establishing the correct drug intervention to be administered at an optimal dose and time, combined with the most effective adjuvant physical therapy to drive stroke recovery.

Lay Abstract

Several drugs, administered in combination with rehabilitation, have been found to increase the amount of physical recovery achieved by a stroke survivor. This paper reviews the published literature to investigate which drugs have the best evidence of efficacy and safety to promote motor recovery after stroke. However, many studies investigating these drugs lack rigor and have little consistency between how trials were performed. Consequently, it is difficult to make a definitive judgement on how safe and effective these drugs are, or to compare drugs to determine superiority. To overcome this, a reporting standard must be developed for trials of these particular drugs. In addition, stricter adherence is necessary to already established reporting standards, including those that outline how parallel group randomized trials and physical interventions embedded within them are described (the Template for Intervention Description and Replication checklist and the Consolidated Standards of Reporting Trials statement, respectively).

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