METAANALYSIS OF ORAL NIMODIPINE TRIALS IN ACUTE ISCHEMIC STROKE

Background and Purpose: A meta-analysis compared the outcome of the 1, 855 patients receiving oral nimodipine 120 mg daily against the 1,864 receiving placebo using all the data from nine controlled studies of n imodipine in acute ischemic stroke, pursuing findings of subgroup anal yses which, in some studies, suggested an important effect on outcome of early therapy and of severity subgroups. Methods: The neurological outcome was classified as 'favorable' when the patient improved by mor e than 50% of their potential to improve related to the baseline neuro logical score (whatever the scale), as compared to patients who either died, deteriorated, did not change, or improved by 50% or less. A fav orable functional outcome was defined as a Barthel score of more than 60 for those studies using this scale or the equivalent on the Mathew disability scale. Results: The pooled odds ratio favored nimodipine fo r the 330 patients treated within 12 h (OR 0.62, 95% CI 0.44-0.87) ver sus the 286 on placebo. Those treated between 13 and 24 h (451 drug, 4 59 placebo) had no benefits, and those treated after 24 h (803 drug, 8 41 placebo) had no effect or a worse clinical outcome. The effect was more evident when the initial neurological scores showed moderate to s evere impairments. No significant effect on outcome was found in the o verall cohort for age, sex, risk factors of diabetes, hypertension, or heart disease. Conclusions: These findings, from pooling data on over 3,700 patients, support the view that early therapy with oral nimodip ine may favorably influence the course of acute ischemic stroke.