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.