The Efficacy and Safety of the Sphingosine-1-Phosphate Receptor Agonist Fingolimod in Cerebrovascular Stroke: A Systematic Review and Meta-analysis

AbstractIntroduction: Stroke is a leading cause of morbidity and mortality worldwide, with limited effective treatment options. Fingolimod has been shown to have neuroprotective effects in previous studies and has been approved for use in multiple sclerosis. This systematic review aims to evaluate the current evidence regarding the efficacy of Fingolimod in cerebrovascular stroke.Methods: A comprehensive literature search was conducted using electronic databases (PubMed, Scopus, Cochrane Library, and Web of Science) for studies published up to January 2023. Studies were included if they evaluated the efficacy of Fingolimod in subjects with cerebrovascular stroke and reported outcomes.Results: This meta-analysis included six studies with a total of 251 patients, 124 in the fingolimod group and 127 in the control group. Fingolimod was associated with significant improvements in NIHSS scores on days 7, 14, 30, and 90 post-stroke, with the greatest improvement seen after one month (MD = -7.1, 95% CI [-9.73, -4.65], P < 0. 00001). Additionally, fingolimod was associated with significant reductions in mRS scores after three months (MD = 7.3, 95% CI [3.06, 17.40], P < 0. 00001) and significant improvements in Modified Barthel Index scores on days 7, 14, 30, and 90 post-stroke. After three months, the mean difference in Modified Barthel Index scores was 14.6 (95% CI [5.80, 23.36], P = 0.0005). Fingolimod was also associated with significant reductions in microvascular permeability ratio (rT%) and infarct volume (MD = -15.2, 95% CI [-23.33, -7.15], P < 0. 00001).Conclusion: The current evidence suggests that Fingolimod may have potential as a neuroprotective agent in cerebrovascular stroke. However, more high-quality clinical trials are warranted.