Clinical efficacy of edaravone dexborneol in the treatment of acute ischemic stroke: meta-analysis

Background In China, edaravone dexborneol (ED) is often used to treat acute ischemic stroke (AIS), but internationally, ED is not commonly used. This study aimed to conduct a meta-analysis on the application of ED in AIS, so as to provide reference and guidance for clinical use in the future. Methods Pubmed and Web of Science databases were searched for articles on ED in the treatment of AIS. Two researchers independently searched the articles based on pre-specified inclusion (randomized controlled trial, complete data, correct logic, English literature, etc.) and exclusion criteria (studies lacking objective reference standards, studies with follow-up success rates below 80%, etc.), and duplicate articles were excluded using Endnote. The search was set for the build time to December 2024. Then, the initially enrolled articles were subjected to information and data extraction and crosschecking, followed by meta analysis using the RevMan 5.3 software after screening. Primary outcome measures included clinical efficacy, safety, and NIHSS. Results A total of 5 articles were included after screening, totaling 2,651 study participants. Subjects in the 5 articles were divided into an experimental group (ED treatment, n = 1,465) and a control group (other treatment regimen(s), n = 1,226). All the articles were of high quality and high reference value. According to Meta-analysis, no statistically significant difference was observed in the incidence of adverse reactions between the ED and control groups (95%CI = 0.67 ~ 1.04, p = 0.11), but the clinical efficacy in the experimental group exhibited significantly better outcomes compared to the control group (95%CI = 0.03 ~ 0.09, p = 0.0002). In addition, NIHSS (95%CI = −4.67 ~ −0.13, p = 0.04) and hs-CRP (95%CI = −1.90 ~ −0.23, p = 0.01) were lower in the experimental group than in the control group. Funnel plots were drawn for outcome measures with heterogeneity. The results showed that the funnel plot of the NIHSS scores and hs-CRP were basically symmetrical. Conclusion While ED demonstrates short-term efficacy in improving neurological outcomes, its clinical applicability remains uncertain due to unresolved questions about drug diffusion and delivery in human brain tissue, which may fundamentally limit its long-term benefits.