Citicoline for the Treatment of Head Injury: A Systematic Review and Meta-analysis of Controlled Clinical Trials

Abstract

Background: Citicoline is a neuroprotective/neurorestorative drug used in several countries for the treatment of traumatic brain injury (TBI). After the publication of the controversial COBRIT trial, the use of citicoline has been questioned in this use, so it has been considered necessary to undertake a systematicreview to evaluate if citicoline is effective in the treatment of patients with traumatic braininjury. Methods: A systematic search was performed on Medline, Embase, and Ferrer databases to identify all published, unconfounded, comparative clinical trials of citicoline in acute phase head injured patients. Results: 12 controlled trials enrolling 2706 patients were identified. Under the random-effects model, the meta- analysis shows an 1.815 (IC 95% 1.302; 2.530) in favour of citicoline in the rates of independence, using as a measure the Glasgow Outcome Scale. The effect of citicoline has been diluted across time in parallel with the improvement of the standard of care of this kind of patient, as demonstrated by the cumulative meta-analysis technique. Conclusion: Formal meta-analysis of comparative trials of citicoline in TBI shows a beneficial treatment effect, without safety concerns.