Safety and efficacy of recovery-promoting drugs for motor function after stroke: A systematic review of randomized controlled trials

Objective: To investigate the efficacy and safety of drug interventions to promote motor recovery poststroke. Data sources: CENTRAL, CINAHL, Embase, MEDLINE, SCOPUS and Web of Science. Study selection: Published human randomized controlled trials in which the primary intervention was a drug administered to promote motor recovery poststroke, vs placebo. Data extraction: Standardized pro forma used to extract safety and efficacy data; Cochrane Collaboration risk of bias assessment tool performed to assess risk of bias. Data synthesis: Fifty randomized controlled trials from 4,779 citations were included. An overall trend of high risk of attrition (n=27) and reporting bias (n=36) was observed. Twenty-eight different drug interventions were investigated, 18 of which demonstrated statistically significant results favouring increased motor recovery compared with control intervention. Forty-four studies measured safety; no major safety concerns were reported. Conclusion: Candidate drug interventions promoting motor recovery post-stroke were identified, specifically selective serotonin reuptake inhibitors and levodopa; however, the high risk of bias in many trials is concerning. Drugs to improve motor function remain an important area of enquiry. Future research must focus on establishing the right drug intervention to be administered at an optimal dose and time, combined with the most effective adjuvant physical therapy to drive stroke recovery.