Theophylline, aminophylline, caffeine and analogues for acute ischaemic stroke

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Abstract
Theophylline causes potent cerebral vasoconstriction which decreases blood flow in the non-ischaemic areas of the brain and increases collateral blood flow surrounding the ischaemic region. The objective of this review was to assess the effect of theophylline and its analogues (aminophylline and caffeine) in people with confirmed or presumed acute ischaemic stroke. We searched the Cochrane Stroke Group trials register (last searched: March 1999), Medline (from 1965), Embase (from 1980), and ISI (from 1981). We contacted drug companies. Randomised trials of theophylline or an analogue compound compared with placebo or control in people with confirmed or presumed acute ischaemic stroke. Trials were included if treatment was started within one week of stroke onset. Three reviewers applied the inclusion criteria, assessed trial quality and extracted data. Two trials involving 119 patients were included. Trial quality was good. Both of the trials tested aminophylline. Analysis was by intention-to-treat where possible. No difference was shown in early death (within four weeks) between aminophylline and placebo (odds ratio 1.12, 95% confidence interval 0.49 to 2.56). There was no significant difference for early mortality and deterioration (odds ratio 0.87, 95% confidence interval 0.41 to 1.88). Death or disability was not reduced by treatment based on 73 patients in one trial (odds ratio 0.64, 95% confidence interval 0.24 to 1.68). Data for late mortality and disability were not in a form suitable for analysis. No data on quality of life were available. There is not enough evidence to assess whether theophylline or its analogues reduce mortality or morbidity, or are safe, in people with acute ischaemic stroke.