Minocycline in acute stroke: A systematic review and meta-analysis of randomized controlled trials and trial sequential analysis.
Muhammad Shahzaib, Muhammad Roshaan, Gaaitri Lohano et al.
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In 30 seconds
This systematic review and meta-analysis pooled randomized controlled trials comparing minocycline with control or standard care in acute ischemic and hemorrhagic stroke. Across nine trials involving 2186 participants, minocycline was associated with lower 3-month NIHSS scores in ischemic stroke (mean difference -2.43, 95% CI -4.42--0.44; P = .0169). Functional independence at 3 months also favored minocycline for modified Rankin Scale scores of 0 to 2, but the authors considered the evidence exploratory because of heterogeneity, low certainty, and inconclusive trial sequential analysis.
Key findings
- In acute ischemic stroke, 3-month NIHSS scores were lower with minocycline (mean difference -2.43, 95% CI -4.42--0.44; P = .0169).
- Functional independence (modified Rankin Scale 0 to 2) favored minocycline in ischemic stroke (risk ratio 1.40, 95% CI 1.05-1.86; P = .0219).
- Modified Rankin Scale 0 to 1 was not significantly improved; Barthel Index results favored minocycline but were not statistically significant overall.
- Mortality and the reported vascular, hemorrhagic, imaging, and Matrix Metalloproteinase-9 outcomes were not significantly altered.
Why it matters
The findings suggest a possible neurological recovery benefit from minocycline in acute ischemic stroke, while showing no established benefit in intracerebral hemorrhage or across several safety-related outcomes. Because the evidence is low certainty and trial sequential analysis was inconclusive, the apparent benefit should be interpreted cautiously rather than as definitive evidence of efficacy.
What to keep in mind
The authors report substantial heterogeneity, low-certainty evidence, and inconclusive trial sequential analysis; the pooled findings therefore do not support definitive conclusions.