A 2025 systematic review scrutinized the efficacy and safety of various pharmacological treatments targeting the acute phase of secondary spinal cord injury (SCI). This review aggregated data from 25 studies encompassing 3017 patients, with an average age of 43.3 years. It aimed to evaluate current management strategies and identify potential therapeutic options to improve outcomes in SCI patients. The findings highlighted that erythropoietin (EPO) was associated with improved motor function and reduced neurological impairment post-SCI, attributed to its antioxidative, anti-apoptotic, and neurogenic properties. Despite its widespread use, methylprednisolone demonstrated uncertain efficacy in enhancing neurological outcomes, aligning with previous evidence suggesting a risk of adverse effects. The review also emphasized the promising potential of monosialotetrahexosylganglioside sodium salt (GM-1) and riluzole, both of which were linked to favorable neurological outcomes. Riluzole has demonstrated neuroprotective effects in preclinical SCI models, including reduced tissue damage and preservation of white matter, motor neurons, and mitochondrial function, findings that suggest potential for improved functional recovery. Clinically, Grossman et al. showed that patients treated within 12 hours of injury had significantly better motor, sensory, and impairment outcomes at 90 days (See Table 3). Additionally, granulocyte colony-stimulating factor (G-CSF) and hepatocyte growth factor (HGF) were noted for providing enhanced motor scores with fewer side effects. However, therapies involving the rho-GTPases inhibitor VX-210 and levetiracetam did not show significant efficacy, underscoring the need for continued research to optimize pharmacological interventions for secondary SCI. [1]
Another 2024 systematic review with meta-analyses evaluated specifically the safety and efficacy of riluzole in the treatment of traumatic SCI. The five included studies varied in design, with four being prospective and randomized, and one being prospective and non-randomized. The participants across these studies encompassed 378 individuals, of whom 187 received riluzole, compared against control groups comprising 191 individuals receiving either placebo or standard care without specific additional interventions. The studies spanned various global locations, including North America, Australia, India, and Iran, and involved administering riluzole in different dosing regimens, most commonly 100 mg PO BID initially, followed by 50 mg BID for a period ranging from 13 days (50 mg BID 8 weeks; 1 study). Regarding acuity of injury, all studies were within the acute period post-SCI. The results indicated a non-significant trend toward improved neurological outcomes in the riluzole group as measured by the American Spinal Injury Association (ASIA) motor scores and ASIA Impairment Scale (AIS) changes at three and six months post-injury. Statistically, riluzole administration resulted in neither a significant reduction in adverse events (AEs) nor mortality when compared to controls. Despite the potential promise suggested by these outcomes, the improvements did not reach statistical significance, highlighting the need for more robust, large-scale randomized trials to establish definitive conclusions about riluzole’s therapeutic role in acute traumatic SCI. The studies also noted the absence of specific AEs directly attributable to riluzole, underscoring its safety profile within the studied parameters. [2]