The efficacy of different doses of citicoline in improving the prognosis of patients with acute ischemic stroke based on Network meta-analysis

Xu Zhao ¹ Xianhao Huo ² Yizhen Meng ³ Ran Zhao ¹ Xiaozhuo Liu ¹ Jiancheng Chen ⁴ Zhiqi Mao ⁵ Mei Li ^5*

• ¹ Department of Neurosurgery, Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei Province, China
• ² Department of Neurosurgery, General Hospital of Ningxia Medical University, Yichuan, China
• ³ Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei Province, China
• ⁴ Department of Neurology, The Second Affiliated Hospital, Hengyang Medical School University of Sourth China, Hunan, China
• ⁵ Department of Neurosurgery, Chinese PLA General Hospital, Beijing, Beijing Municipality, China

Objective: Our group aim to explore the effect of different dosages of citicoline on ischemic stroke (IS) patients, and to determine the most appropriate dosage for these patients.The databases of Pubmed, Cochrane library, Medline, Web of science, and Embase were searched from the establishment to October 15, 2024. We assessed the quality of the all included articles by using the Cochrane quality evaluation method or Newcastle-Ottawa Scale (NOS), which was based on the study type. Relative risk (RR) and 95% confidence interval (CI) were used for dichotomous data, mean and standardized difference (SD) were used for continuous data. The outcome indicators were death, the improvement of neurological function and daily living activities, and adverse effect.In this study, a total of 13 studies were included. Of these, 370 patients were treated by 500mg-Citicoline, 502 patients were treated by 1000mg-Citicoline, 1891 patients were treated by 2000mg-Citicoline, and 2582 patients were treated in the group of Control (CON). We evaluated the treatment effect of different outcome indicators by ranking. In the terms of death, both 500mg-citicoline and 2000mg-citicoline demonstrated lower mortality than CON, with the 2000mg-citicoline having the lowest mortality. In terms neurological function improvement, we found that compared to the CON, the rates of improvement were higher and the rates of ineffective result were lower in the 500mg-Citicoline, 2000mg-Citicoline, and 1000mg-Citicoline groups. In terms of improvement in daily living activities, the MBI scores for 500mg-Citicoline and 2000mg-Citicoline were both higher than the CON, while the MBI score for 1000mg-Citicoline was not. Lastly, in the aspect of adverse effect, we found that the rate of adverse effect was lower for 1000mg-Citicoline than CON, while it was higher for 500mg-Citicoline and 2000mg-Citicoline.Our research findings revealed that different dosages of citicoline significantly affect the neurological function, daily living activities, and adverse effect in patients with acute IS. Notably, 500mg-Citicoline and 2000mg-Citicoline not only demonstrate higher rates of improvement in neurological function and daily living activities but also have lower mortality and ineffective result. However, this study does not specify which is the best one of the two dosages.