Comparative efficacy and safety of four immunomodulatory agents for acute spinal cord injury: a systematic review and Bayesian network meta-analysis
- 1Department of Ophthalmology, The Second Xiangya Hospital, Central South University , ,
Abstract
Study Design: Systematic review and Bayesian network meta-analysis.
Objective: To compare the efficacy and safety of methylprednisolone (MP), erythropoietin (EPO), granulocyte colony-stimulating factor (G-CSF), and minocycline for the treatment of acute spinal cord injury (ASCI).
Methods: MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov were searched from inception to 15 June 2025. Randomized and nonrandomized comparative studies were eligible. Bayesian random-effects network meta-analyses compared MP, EPO, EPO plus MP, G-CSF, and minocycline. Treatment effects were reported as odds ratios (ORs) or mean differences (MDs) with 95% credible intervals (CrIs). Model convergence and fit, heterogeneity, predictive intervals, and global and local inconsistency were evaluated. Follow-up-stratified and exploratory restriction analyses were performed where feasible. Formal comparison-level Confidence in Network Meta-Analysis (CINeMA) assessment was not feasible; certainty was appraised qualitatively across its six domains.
Results: Twenty comparative reports were included: nine randomized and 11 nonrandomized reports. For neurological grade improvement, G-CSF was associated with higher odds of improvement than the common control node (OR = 5.12, 95% CrI 1.15–32.42). Estimates for EPO (OR = 4.87, 95% CrI 0.44–135.90), EPO plus MP (OR = 3.44, 95% CrI 0.09–164.02), and MP (OR = 1.31, 95% CrI 0.30–5.72) were imprecise and included the null. For change in ASIA Motor Score, G-CSF had the largest point estimate (MD = 11.49, 95% CrI −0.44 to 23.49), followed by minocycline (MD = 6.83, −15.24–28.75), EPO (MD = 6.75, −13.16–26.42), and MP (MD = 2.28, −6.24–10.94); all credible intervals crossed zero. For overall adverse events, the estimate for MP was imprecise (OR = 1.13, 95% CrI 0.58–2.34), while the G-CSF effect was not reliably estimable because near-complete event occurrence produced a highly prior-sensitive posterior. Other safety estimates were imprecise.
Conclusion: G-CSF showed a potential beneficial signal for neurological grade improvement. However, the limited evidence base, inclusion of nonrandomized and nonconcurrent comparisons, substantial heterogeneity, wide credible and predictive intervals, and uncertain transitivity preclude definitive conclusions about comparative efficacy or safety. Treatment rankings should be regarded as exploratory and do not establish the superiority of any intervention.
Systematic Review registration: https://www.crd.york.ac.uk/PROSPERO/view/ , identifier CRD420251027856.
Related
- Comparative Efficacy and Safety of Systemic Immunomodulatory Therapies for Non‐Infectious Uveitis: A Systematic Review With Pairwise and Network Meta‐Analyses
- Comparative efficacy and safety of six traditional Chinese medicine injections for ischemic heart failure: a systematic review and Bayesian network meta-analysis
- Comparative Efficacy of Ritlecitinib, Baricitinib, and Upadacitinib in Adolescents With Severe Alopecia Areata: A Bayesian Network Meta‑Analysis
- Comparative efficacy of common adjuvant treatments after resection of colorectal liver metastases : A systematic review and network meta-analysis
- Comparative efficacy and safety of targeted disease-modifying therapies in adults with primary IgA nephropathy: a systematic review and network meta-analysis
BibTeX
@article{peng2026comparative,
title = {{Comparative efficacy and safety of four immunomodulatory agents for acute spinal cord injury: a systematic review and Bayesian network meta-analysis}},
author = {Yue Peng and Binghan Cai and Yuerong Ren and Qian Jiang and Bing Jiang and Lili Xie},
journal = {Frontiers in pharmacology},
year = {2026},
month = oct,
doi = {10.3389/fphar.2026.1942918},
url = {https://europepmc.org/article/PMC/PMC13668820},
note = {CC BY},
}
RIS
TY - JOUR
TI - Comparative efficacy and safety of four immunomodulatory agents for acute spinal cord injury: a systematic review and Bayesian network meta-analysis
AU - Yue Peng
AU - Binghan Cai
AU - Yuerong Ren
AU - Qian Jiang
AU - Bing Jiang
AU - Lili Xie
PY - 2026
DA - 2026/10/01
JO - Frontiers in pharmacology
DO - 10.3389/fphar.2026.1942918
UR - https://europepmc.org/article/PMC/PMC13668820
AB - Study Design: Systematic review and Bayesian network meta-analysis. Objective: To compare the efficacy and safety of methylprednisolone (MP), erythropoietin (EPO), granulocyte colony-stimulating factor (G-CSF), and minocycline for the treatment of acute spinal cord injury (ASCI). Methods: MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov were searched from inception to 15 June 2025. Randomized and nonrandomized comparative studies were eligible. Bayesian random-effects network meta-analyses compared MP, EPO, EPO plus MP, G-CSF, and minocycline. Treatment effects were reported as odds ratios (ORs) or mean differences (MDs) with 95% credible intervals (CrIs). Model convergence and fit, heterogeneity, predictive intervals, and global and local inconsistency were evaluated. Follow-up-stratified and exploratory restriction analyses were performed where feasible. Formal comparison-level Confidence in Network Meta-Analysis (CINeMA) assessment was not feasible; certainty was appraised qualitatively across its six domains. Results: Twenty comparative reports were included: nine randomized and 11 nonrandomized reports. For neurological grade improvement, G-CSF was associated with higher odds of improvement than the common control node (OR = 5.12, 95% CrI 1.15–32.42). Estimates for EPO (OR = 4.87, 95% CrI 0.44–135.90), EPO plus MP (OR = 3.44, 95% CrI 0.09–164.02), and MP (OR = 1.31, 95% CrI 0.30–5.72) were imprecise and included the null. For change in ASIA Motor Score, G-CSF had the largest point estimate (MD = 11.49, 95% CrI −0.44 to 23.49), followed by minocycline (MD = 6.83, −15.24–28.75), EPO (MD = 6.75, −13.16–26.42), and MP (MD = 2.28, −6.24–10.94); all credible intervals crossed zero. For overall adverse events, the estimate for MP was imprecise (OR = 1.13, 95% CrI 0.58–2.34), while the G-CSF effect was not reliably estimable because near-complete event occurrence produced a highly prior-sensitive posterior. Other safety estimates were imprecise. Conclusion: G-CSF showed a potential beneficial signal for neurological grade improvement. However, the limited evidence base, inclusion of nonrandomized and nonconcurrent comparisons, substantial heterogeneity, wide credible and predictive intervals, and uncertain transitivity preclude definitive conclusions about comparative efficacy or safety. Treatment rankings should be regarded as exploratory and do not establish the superiority of any intervention. Systematic Review registration: https://www.crd.york.ac.uk/PROSPERO/view/ , identifier CRD420251027856.
SN - 1663-9812
ER -