Impact of Amantadine on Inflammatory Biomarkers in Traumatic Brain Injury Patients: A Randomized Controlled Trial

Document Type : Original Article

Authors

1 Associate Professor of Clinical Pharmacy & Pharmacy Practice - Faculty of Pharmacy, Damanhour University, Damanhour, Egypt.

2 Ministry of Health and Population, Alexandria, Egypt.

3 Associate Professor of Emergency Medicine and Traumatology, Faculty of Medicine, Tanta University, Tanta, Egypt.

4 Professor of Pharmacology & Toxicology, Faculty of Pharmacy, Damanhour University, Damanhour, Egypt.

Abstract

Background and aim
Traumatic brain injury (TBI) is considered a challenge for health care systems. This study aimed to assess amantadine as an add-on therapy for TBI patients.
Methods
Fifty TBI patients were divided randomly into two groups (n=25 each) to receive either placebo or amantadine (100 mg twice daily) for 6 weeks. Neuron-specific enolase (NSE), neurotensin 3 (NT3), interleukin-18 (IL-18) serum levels and the Glasgow coma score (GCS) were assessed before and after treatment.
Results
There was a significant difference in NSE (p=0.01), NT-3 and IL-18 (p<0.001) after 6 weeks of treatment between the two groups. The extended Glasgow Outcome Scale (GOS-E, p=0.008) and GCS (p=0.04) scores after six weeks were significantly different between both groups. Insignificant difference was found between the two groups regarding the overall survival (p = 0.653). NT3 was the most sensitive predictor of good prognosis (AUC= 1.000, p<0.001), followed by IL-18 (AUC=0.997, p<0.001).
Conclusions
As an adjunctive treatment, amantadine may protect neurons throughout the later stages of traumatic brain injury (TBI). Compared with placebo, amantadine therapy was associated with a higher GCS score six weeks after admission and greater reductions in NSE, NT-3, and IL-18. Additionally, NT-3 and IL-18 are promising prognostic biomarkers for TBI patients.

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