TOPLINE:

Amantadine, alone or in combination with nutritional supplement citicoline, was associated with greater recovery of consciousness and cognitive behavior in patients with moderate traumatic brain injury (TBI) than citicoline alone, with shorter durations of mechanical ventilation and ICU and/or hospital stays, a new randomized trial showed.

METHODOLOGY:

• Researchers conducted a prospective randomized trial in Egypt and enrolled 45 patients aged 16-65 years with moderate nonpenetrating TBI and Glasgow Coma Scale (GCS) scores of 9-12.
• Patients were randomly assigned to one of three treatment groups with 15 participants each: citicoline alone (mean age, 36 years; 80% men), amantadine alone (mean age, 35 years; 73% men), or amantadine plus citicoline (mean age, 36 years; 87% men).
• All treatments were administered intravenously for 7 days, followed by oral or enteral therapy up to 30 days. Patients were followed up until death or completion of the 30-day study period.
• The primary outcome was recovery of consciousness, as measured with the GCS. Secondary outcome measures included Disability Rating Scale (DRS) and Mini-Mental State Examination (MMSE) scores on days 1, 4, and 7 (acute phase in the ICU) and on day 30, as well as number of ventilator days, mortality, length of ICU and hospital stays, and drug-related adverse events (AEs).

TAKEAWAY:

• Recovery of consciousness at day 30 was significantly greater in patients who received amantadine plus citicoline or amantadine alone than in those who received citicoline alone (mean change in GCS score, +2.5 and +2.1 vs +1.1, respectively; P < .001 for both), with the nonsignificant differences between the amantadine and combination groups.
• Functional disability alleviation at day 30 was also greater with combination and amantadine-only therapy than with citicoline-only therapy (mean change in DRS score, -6.2 and -4.9 vs -2.4; P < .001 for both).
• Although cognitive recovery increased significantly in all groups, it occurred earlier (by day 4) and was greater in the combination and amantadine groups at day 30 than in the citicoline group (mean changes in MMSE score, +4.2 and +3.9 vs +1.1; P < .001 for both); the scores did not differ significantly between the two amantadine groups.
• The citicoline group had a longer duration of mechanical ventilation than the amantadine and combination groups (6.0 vs 3.0 and 3.2 days, respectively; P = .01), as well as longer ICU stays (P < .001) and hospital stays (P < .001); but mortality rates and AEs were similar across the groups.

IN PRACTICE:

“This study showed that using amantadine alone or in combination with citicoline has a favorable effect on the recovery of consciousness and cognitive behavior in patients with moderate TBI with shorter durations of mechanical ventilation, ICU, and hospital stay,” the investigators wrote.

SOURCE:

The study was led by Dina Salah Eldin Mahmoud Badre, MD, Ain Shams University, Cairo, Egypt. It was published online on January 20 in the Journal of Neurotrauma.

LIMITATIONS:

The study was limited by the absence of a control group, and therefore, whether improvements in the citicoline group were due to natural recovery after TBI could not be validated. The sample size was also small, the follow-up duration was short, and long-term functional outcomes could not be assessed.

DISCLOSURES:

The study did not receive any funding. The investigators reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.