Strengths and limitations
Our meta-analysis aimed to present efficacy and safety data. To date, no meta-analysis has been published about the effects and safety of fingolimod for AIS. Limitations of this study:1) Although the search strategy is relatively complete, it does not rule out that eligible articles are not included 2) A large sample of studies lacked in the included studies 3) the fact that it only includes randomized controlled trials 4) It is not distinguished patients who receive different standard treatments such as the intravenous administration of tPA, intravascular therapy, antiplatelet drugs and so on. 5) Four of the included trials came from the same group of investigators 6) Four of the excluded studies’ data are not extractable. The records with unobtainable data may cause bias in the results. 7) None of the included trials were double-blinded(most had a PROBE design). 8) High heterogeneity across studies should not be neglected, though a random-effects model was used for adjustment. Nonetheless, results were broadly similar even if sensitivity analysis which decreased the heterogeneity, were performed. Inherent limitations in the majority of meta-analyses, such as lack of access to raw data and the variety in definitions of outcomes in the included studies, are unavoidable. None of the included studies was adequately sized to evaluate the proposed primary endpoint. 9) The entire data were derived from patients in China. More studies are needed that include other ethnic groups. 10) Different inclusion/exclusion criteria and follow-up periods in the included studies led to high heterogeneity. 10) The treatment of five included studies did not cover intravascular therapy. RCTs with greater patient numbers will be needed for future studies.