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On the limits of Citicoline and the need for comprehensive brain injury rehabilitation

Citi­co­l­ine does not improve func­tion­al, cog­ni­tive sta­tus in patients with trau­mat­ic brain injury (Out­come Mag­a­zine):

Although approved for use for treat­ing trau­mat­ic brain injury (TBI) in near­ly 60 coun­tries, use of citi­co­l­ine in a ran­dom­ized tri­al that includ­ed more than 1,200 par­tic­i­pants with TBI did not result in improve­ment in func­tion­al and cog­ni­tive sta­tus, accord­ing to a study appear­ing in the Novem­ber 21 issue of JAMA.

Despite con­sid­er­able advances in emer­gency and crit­i­cal care man­age­ment of TBI as well as decades of research on poten­tial agents for neu­ro­pro­tec­tion or enhanced recov­ery, no effec­tive phar­ma­cother­a­py has yet been iden­ti­fied”…Citi­co­l­ine is wide­ly avail­able in the Unit­ed States as a nutraceu­ti­cal (prod­uct that report­ed­ly pro­vides health and med­ical ben­e­fits) and is used by patients with a range of neu­ro­log­ic dis­or­ders, yet it has not been eval­u­at­ed in a large ran­dom­ized clin­i­cal tri­al for TBI.

In an accom­pa­ny­ing editorial…write that the pri­ma­ry impor­tance report­ed by this tri­al “is that it con­clu­sive­ly demon­strat­ed the lack of effi­ca­cy of citi­co­l­ine monother­a­py for TBI…The broad­er impli­ca­tion may be that no sin­gle ther­a­peu­tic agent is like­ly to be suf­fi­cient to improve func­tion­al out­comes for patients with TBI. The diverse and com­plex nature of the patho­log­i­cal mech­a­nisms acti­vat­ed by TBI sug­gests that mul­ti­modal treat­ment inter­ven­tions may be need­ed to improve recov­ery. Future stud­ies of TBI treat­ment should be designed to incor­po­rate mul­ti­ple treat­ment inter­ven­tions and com­pre­hen­sive TBI reha­bil­i­ta­tion strate­gies, either as com­po­nents of the inter­ven­tion or stan­dard­ized across study treat­ment groups.”

Study: Effect of Citi­co­l­ine on Func­tion­al and Cog­ni­tive Sta­tus Among Patients With Trau­mat­ic Brain Injury Citi­co­l­ine Brain Injury Treat­ment Tri­al (JAMA). From the Abstract:

  • Con­text: Trau­mat­ic brain injury (TBI) is a seri­ous pub­lic health prob­lem in the Unit­ed States, yet no treat­ment is cur­rent­ly avail­able to improve out­come after TBI. Approved for use in TBI in 59 coun­tries, citi­co­l­ine is an endoge­nous sub­stance offer­ing poten­tial neu­ro­pro­tec­tive prop­er­ties as well as facil­i­tat­ed neu­rore­pair post injury.
  • Con­clu­sion: Among patients with trau­mat­ic brain injury, the use of citi­co­l­ine com­pared with place­bo for 90 days did not result in improve­ment in func­tion­al and cog­ni­tive sta­tus.

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