Melbourne study supports tenecteplase use in mobile stroke units


By Mardi Chapman

5 May 2022

Early tenecteplase treatment has benefits over alteplase when provided in the pre-hospital setting of the Melbourne Mobile Stroke Unit (MSU).

The phase 2 TASTE-A study, published in The Lancet Neurology and presented at the European Stroke Organisation Conference (ESCO), randomised 104 adults with ischaemic stroke to either standard of care alteplase (0·9 mg/kg, IV infusion over an hour) or tenecteplase (0·25 mg/kg, IV bolus).

The study found the primary outcome, the volume of the perfusion lesion on CT-perfusion imaging on arrival at the receiving hospital, was significantly smaller in patients treated with tenecteplase than alteplase (12 v 35 ml; IRR 0.55; p = 0.0030).

“Patients also had a greater reduction in the prespecified secondary efficacy outcome of median NIHSS between MSU and emergency department arrival when treated with tenecteplase (median NIHSS reduction 1, IQR 0–6) compared with patients treated with alteplase (median NIHSS reduction 0, 0–3; adjusted difference in medians 1·0, 95% CI 0·1–1·9; p=0·030).”

It said thrombolytic treatment was initiated significantly faster from the time of MSU arrival with tenecteplase than alteplase (30 v 37 mins; p=0.005).

“This time saving was due to avoidance of needing to prepare a 1-h infusion of alteplase as the longer half-life of tenecteplase allows a single bolus to be administered.”

Patients treated with tenecteplase also had a higher proportion of distal clot migration between pretreatment MSU scanning and post treatment emergency department scanning (36% v 16%; OR 2·9, 95% CI 1·1–7·5; p=0·024).

“Clot migration is a clear biological measure of thrombolytic success, and the increased rate of clot migration in the tenecteplase treated patients supports the study findings of reduced perfusion lesion volumes and greater ultra-early clinical improvement with tenecteplase treatment,” the study said.

Just under a quarter of patients in both groups required subsequent thrombectomy (24% v 22%).

There were no significant differences between the treatment groups on any mRS outcomes at 90 days and the number of deaths (five in each group).

The study, led by Professor Andrew Bivard from the Melbourne Brian Centre at the Royal Melbourne Hospital, said the findings support the use of tenecteplase and MSUs in an optimal model of stroke care.

Watch Professor Andrew Bivard in a short press presentation at ESCO.

A Comment article in the journal said results from other trials comparing tenecteplase with alteplase including ACT and ATTEST2 were eagerly anticipated.

“Definitive proof of non-inferiority or efficacy of tenecteplase over alteplase for the treatment of acute stroke is still awaited, and confirmation is needed that the 0·25 mg/kg dose will be the most appropriate for these patients,” it said.

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