Cilostazol mono and combination treatments in ischemic stroke an updated systematic review and meta-analysis

Seung Min Kim; Jin Man Jung; Bum Joon Kim; Ji Sung Lee; Sun U. Kwon

doi:10.1161/STROKEAHA.119.026655

Cilostazol mono and combination treatments in ischemic stroke an updated systematic review and meta-analysis

Seung Min Kim, Jin Man Jung, Bum Joon Kim, Ji Sung Lee, Sun U. Kwon

Research output: Contribution to journal › Article › peer-review

24 Citations (Scopus)

Abstract

Background and Purpose?We performed a systematic review and meta-analysis to explore the efficacy and safety ofcilostazol as a mono or combination (plus aspirin or clopidogrel) treatments compared to conventional single antiplatelettherapy (SAPT, mainly aspirin) for secondary stroke prevention.Methods?Randomized controlled trial studies were searched across multiple comprehensive databases (MEDLINE,EMBASE, and Cochrane) for review. The primary outcome was recurrent stroke comprising ischemic and hemorrhagicstroke. Secondary outcomes included ischemic stroke, hemorrhagic stroke, myocardial infarction, and compositeoutcomes. We performed an updated systematic review and meta-analysis of the identified reports, including 2 recentlypublished randomized controlled trials. In addition, network meta-analysis was performed to compare the relative effectsof mono versus combination cilostazol treatments.Results?Ten studies were included in this review, 5 of which were assigned to the cilostazol mono group (n=5429) andthe other 5 to the combination group (n=2456). The relative risks of recurrent stroke, ischemic stroke, and compositeoutcomes with cilostazol mono as well as combination treatments were significantly lower than with SAPT without anysignificant heterogeneity. An indirect comparison of these 3 outcomes revealed the cilostazol combination approach to besuperior. The cilostazol mono treatment diminished hemorrhagic stroke more significantly than SAPT and the cilostazolcombination did not increase hemorrhagic stroke compared to SAPT. The outcomes from the 2 cilostazol regimens werecomparable to SAPT in the case of myocardial infarction.Conclusions?Cilostazol is a more effective and safer treatment option than SAPT approaches using mainly aspirin.Cilostazol regimens can also be modified to clinical situations as this drug reduces recurrent and ischemic strokemore efficiently as a combination therapy but is more beneficial for hemorrhagic stroke as a monotherapy.

Original language	English
Pages (from-to)	3503-3511
Number of pages	9
Journal	Stroke
Volume	50
Issue number	12
DOIs	https://doi.org/10.1161/STROKEAHA.119.026655
Publication status	Published - 2019 Dec 1

Keywords

Aspirin
Cilostazol
Meta-analysis
Safety
Systematic review

ASJC Scopus subject areas

Clinical Neurology
Cardiology and Cardiovascular Medicine
Advanced and Specialised Nursing

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10.1161/STROKEAHA.119.026655

Cite this

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title = "Cilostazol mono and combination treatments in ischemic stroke an updated systematic review and meta-analysis",

abstract = "Background and Purpose?We performed a systematic review and meta-analysis to explore the efficacy and safety ofcilostazol as a mono or combination (plus aspirin or clopidogrel) treatments compared to conventional single antiplatelettherapy (SAPT, mainly aspirin) for secondary stroke prevention.Methods?Randomized controlled trial studies were searched across multiple comprehensive databases (MEDLINE,EMBASE, and Cochrane) for review. The primary outcome was recurrent stroke comprising ischemic and hemorrhagicstroke. Secondary outcomes included ischemic stroke, hemorrhagic stroke, myocardial infarction, and compositeoutcomes. We performed an updated systematic review and meta-analysis of the identified reports, including 2 recentlypublished randomized controlled trials. In addition, network meta-analysis was performed to compare the relative effectsof mono versus combination cilostazol treatments.Results?Ten studies were included in this review, 5 of which were assigned to the cilostazol mono group (n=5429) andthe other 5 to the combination group (n=2456). The relative risks of recurrent stroke, ischemic stroke, and compositeoutcomes with cilostazol mono as well as combination treatments were significantly lower than with SAPT without anysignificant heterogeneity. An indirect comparison of these 3 outcomes revealed the cilostazol combination approach to besuperior. The cilostazol mono treatment diminished hemorrhagic stroke more significantly than SAPT and the cilostazolcombination did not increase hemorrhagic stroke compared to SAPT. The outcomes from the 2 cilostazol regimens werecomparable to SAPT in the case of myocardial infarction.Conclusions?Cilostazol is a more effective and safer treatment option than SAPT approaches using mainly aspirin.Cilostazol regimens can also be modified to clinical situations as this drug reduces recurrent and ischemic strokemore efficiently as a combination therapy but is more beneficial for hemorrhagic stroke as a monotherapy.",

keywords = "Aspirin, Cilostazol, Meta-analysis, Safety, Systematic review",

author = "Kim, {Seung Min} and Jung, {Jin Man} and Kim, {Bum Joon} and Lee, {Ji Sung} and Kwon, {Sun U.}",

note = "Funding Information: This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and Information and Communications Technology (ICT; NRF-2017R1C1B1009482) and a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI18C2383). Funding Information: Dr Jung has received lecture honoraria from Pfizer, Sanofi-Aventis, Dong-A Pharmaceutical Co, Ltd, and Boryung Pharmaceutical Co, Ltd; a study grant from Il-dong and Cheiljedang Pharmaceutical Co, Ltd; and consulting fees from OBELAB Inc. Dr Kwon has received lecture honoraria from Pfizer, Korea Otsuka, Sanofi-Aventis, Beringer-Ingelheim, MSD, Daiichi Sankyo, Amgen, Bayer, Chongkeundang, Donga, and Boryung Pharm. The other authors report no conflicts. Publisher Copyright: {\textcopyright} 2019 American Heart Association, Inc.",

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doi = "10.1161/STROKEAHA.119.026655",

language = "English",

volume = "50",

pages = "3503--3511",

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T1 - Cilostazol mono and combination treatments in ischemic stroke an updated systematic review and meta-analysis

AU - Kim, Seung Min

AU - Jung, Jin Man

AU - Kim, Bum Joon

AU - Lee, Ji Sung

AU - Kwon, Sun U.

N1 - Funding Information: This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and Information and Communications Technology (ICT; NRF-2017R1C1B1009482) and a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI18C2383). Funding Information: Dr Jung has received lecture honoraria from Pfizer, Sanofi-Aventis, Dong-A Pharmaceutical Co, Ltd, and Boryung Pharmaceutical Co, Ltd; a study grant from Il-dong and Cheiljedang Pharmaceutical Co, Ltd; and consulting fees from OBELAB Inc. Dr Kwon has received lecture honoraria from Pfizer, Korea Otsuka, Sanofi-Aventis, Beringer-Ingelheim, MSD, Daiichi Sankyo, Amgen, Bayer, Chongkeundang, Donga, and Boryung Pharm. The other authors report no conflicts. Publisher Copyright: © 2019 American Heart Association, Inc.

PY - 2019/12/1

Y1 - 2019/12/1

N2 - Background and Purpose?We performed a systematic review and meta-analysis to explore the efficacy and safety ofcilostazol as a mono or combination (plus aspirin or clopidogrel) treatments compared to conventional single antiplatelettherapy (SAPT, mainly aspirin) for secondary stroke prevention.Methods?Randomized controlled trial studies were searched across multiple comprehensive databases (MEDLINE,EMBASE, and Cochrane) for review. The primary outcome was recurrent stroke comprising ischemic and hemorrhagicstroke. Secondary outcomes included ischemic stroke, hemorrhagic stroke, myocardial infarction, and compositeoutcomes. We performed an updated systematic review and meta-analysis of the identified reports, including 2 recentlypublished randomized controlled trials. In addition, network meta-analysis was performed to compare the relative effectsof mono versus combination cilostazol treatments.Results?Ten studies were included in this review, 5 of which were assigned to the cilostazol mono group (n=5429) andthe other 5 to the combination group (n=2456). The relative risks of recurrent stroke, ischemic stroke, and compositeoutcomes with cilostazol mono as well as combination treatments were significantly lower than with SAPT without anysignificant heterogeneity. An indirect comparison of these 3 outcomes revealed the cilostazol combination approach to besuperior. The cilostazol mono treatment diminished hemorrhagic stroke more significantly than SAPT and the cilostazolcombination did not increase hemorrhagic stroke compared to SAPT. The outcomes from the 2 cilostazol regimens werecomparable to SAPT in the case of myocardial infarction.Conclusions?Cilostazol is a more effective and safer treatment option than SAPT approaches using mainly aspirin.Cilostazol regimens can also be modified to clinical situations as this drug reduces recurrent and ischemic strokemore efficiently as a combination therapy but is more beneficial for hemorrhagic stroke as a monotherapy.

AB - Background and Purpose?We performed a systematic review and meta-analysis to explore the efficacy and safety ofcilostazol as a mono or combination (plus aspirin or clopidogrel) treatments compared to conventional single antiplatelettherapy (SAPT, mainly aspirin) for secondary stroke prevention.Methods?Randomized controlled trial studies were searched across multiple comprehensive databases (MEDLINE,EMBASE, and Cochrane) for review. The primary outcome was recurrent stroke comprising ischemic and hemorrhagicstroke. Secondary outcomes included ischemic stroke, hemorrhagic stroke, myocardial infarction, and compositeoutcomes. We performed an updated systematic review and meta-analysis of the identified reports, including 2 recentlypublished randomized controlled trials. In addition, network meta-analysis was performed to compare the relative effectsof mono versus combination cilostazol treatments.Results?Ten studies were included in this review, 5 of which were assigned to the cilostazol mono group (n=5429) andthe other 5 to the combination group (n=2456). The relative risks of recurrent stroke, ischemic stroke, and compositeoutcomes with cilostazol mono as well as combination treatments were significantly lower than with SAPT without anysignificant heterogeneity. An indirect comparison of these 3 outcomes revealed the cilostazol combination approach to besuperior. The cilostazol mono treatment diminished hemorrhagic stroke more significantly than SAPT and the cilostazolcombination did not increase hemorrhagic stroke compared to SAPT. The outcomes from the 2 cilostazol regimens werecomparable to SAPT in the case of myocardial infarction.Conclusions?Cilostazol is a more effective and safer treatment option than SAPT approaches using mainly aspirin.Cilostazol regimens can also be modified to clinical situations as this drug reduces recurrent and ischemic strokemore efficiently as a combination therapy but is more beneficial for hemorrhagic stroke as a monotherapy.

KW - Aspirin

KW - Cilostazol

KW - Meta-analysis

KW - Safety

KW - Systematic review

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Cilostazol mono and combination treatments in ischemic stroke an updated systematic review and meta-analysis

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