Letter by Vester et al Regarding Article, “Hope Dies Last—Evidence Again Fails to Support a Neuroprotectant: Cerebrolysin for Acute Ischemic Stroke”
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To the Editor:
We read with interest the meta-analysis of Ziganshina et al1 and the accompanying Editorial by Bereczki et al2 and value the opinion of our colleagues; however, we disagree with the conclusions in the Editorial and the 2 underlying meta-analyses1,3 about effects of Cerebrolysin in acute ischemic stroke.
Most common outcome measures to assess clinical benefit of pharmacological treatment after acute ischemic stroke are modified Rankin Scale and National Institutes of Health Stroke Scale. The meta-analysis of Ziganshina et al1 provided results only on all-cause deaths to assess benefits of Cerebrolysin. Importantly, the death rate in the selected trials was very low (6.4% for Cerebrolysin versus 6.7% for placebo), which severely limits statistical sensitivity. Furthermore, the analysis ignored the clinical benefit of the survivors, that is, of >93% of the study patients. The International Consortium for Health Outcomes Measurement explicitly warns …