Cerebrolysin

Cerebrolysin is a parenterally administered, porcine brain-derived peptide preparation that has pharmacodynamic properties similar to those of endogenous neurotrophic factors. ^[1] It is a mixture of low-molecular-weight peptides and amino acids derived from porcine brain, which has potential neuroprotective and neurotrophic properties. ^{[2] [3]} It is widely used in the treatment of acute ischaemic stroke in Russia, Eastern Europe, China, and other Asian and post-Soviet countries. ^[2]

It is a mixture of neuropeptides that has similar properties to neurotrophic factors, and its positive impact on strokes has been analyzed. ^[4] It is a combination of amino acids and peptides that mimic the biological functions of neurotrophic factors, and has been shown to improve outcomes after ischemic stroke while preserving a promising safety profile. ^[5] In experimental models of Parkinson's disease, nanowired delivery of cerebrolysin has been described as enhancing neuroprotection by restoring blood-brain barrier breakdown and supporting neuronal plasticity and neuroregeneration. ^[6]

A Cochrane systematic review of seven randomised controlled trials in 1773 participants found that Cerebrolysin or Cerebrolysin-like peptide mixtures probably have no beneficial effect on preventing all-cause death in acute ischaemic stroke. ^[7] In that review Cerebrolysin or Cortexin probably resulted in little to no difference in all-cause death, with a risk ratio of 0.96 and a 95% confidence interval of 0.65 to 1.41 across 6 trials and 1689 participants at moderate-certainty evidence. ^[7] The same review reported a potential increase in the total number of people with non-fatal serious adverse events with Cerebrolysin use, with a risk ratio of 2.39 and a 95% confidence interval of 1.10 to 5.23 across 3 trials and 1335 participants. ^[7] A Cochrane review of six randomised controlled trials in 597 participants concluded that courses of intravenous Cerebrolysin improved cognition and general function in people living with vascular dementia, but that these data are not definitive and the included papers had high risk of bias. ^[8] A meta-analysis of ten clinical studies including 8749 patients found that treatment with Cerebrolysin in traumatic brain injury was associated with a statistically significant change in Glasgow Coma Scale and Glasgow Outcome Scale, while mortality of any cause and length of stay were not affected. ^[9] An updated umbrella review of

In vascular dementia, if there are benefits of Cerebrolysin the effects may be too small to be clinically meaningful, and the supporting evidence base is weak, with analyses limited by heterogeneity and high risk of bias. ^[8] In acute ischaemic stroke the findings of the Cochrane review do not demonstrate clinical benefits of cerebrolysin, and the manufacturer supported several of the multicentre studies either totally or by providing drug, placebo, randomisation codes, research grants, or statisticians. ^[11] Cerebrolysin was generally well tolerated in dementia clinical trials, with dizziness or vertigo being the most frequently reported adverse event. ^[1] Across acute ischaemic stroke trials there was moderate-quality evidence indicating a potential increase in non-fatal serious adverse events, which was more prominent in the subgroup receiving a cumulative dose of 300 mL. ^[2]