Tenecteplase

(TNKase®)

TNKase®

Drug updated on 12/11/2024

Dosage FormInjection (intravenous; 50 mg)
Drug ClassTissue plasminogen activators
Ongoing and
Completed Studies
ClinicalTrials.gov

Indication

  • Indicated to reduce the risk of death associated with acute ST elevation myocardial infarction (STEMI).

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Summary
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  • This summary is based on the review of 23 systematic review(s)/meta-analysis(es). [1-23]
  • Complete Recanalization: In Asian patients, tenecteplase achieved significantly higher rates of complete recanalization (relative risk (RR): 1.91, 95% confidence interval (CI): 1.30 to 2.80), while no significant difference was observed in Caucasian patients compared to alteplase (RR: 0.99, 95% CI: 0.87 to 1.14).
  • Modified Rankin Scale (mRS): At three months, tenecteplase 0.25 mg/kg ranked highest for achieving mRS 0-1 (surface under the cumulative ranking curve (SUCRA) = 0.68) and mRS 0-2 (SUCRA = 0.86), showing similar effectiveness to alteplase in both outcomes.
  • Early Neurological Improvement: Tenecteplase, particularly at the 0.25 mg/kg dose, demonstrated higher rates of early neurological improvement compared to alteplase (OR = 1.52, 95% CI: 1.13-2.05).
  • Extended Time Window (>4.5 hours): Tenecteplase 0.25 mg/kg was associated with a higher likelihood of a 3-month excellent functional outcome (mRS ≤1) compared to no thrombolysis (RR = 1.17, 95% CI: 1.01-1.36).
  • Mortality: Higher mortality rates were observed with tenecteplase compared to alteplase in Asian patients (RR: 1.18, 95% CI: 0.87-1.62).
  • Intracranial Hemorrhage (ICH): Symptomatic and overall ICH rates were similar between tenecteplase and alteplase across various studies, though tenecteplase at 0.40 mg/kg had a higher rate of symptomatic ICH compared to 0.25 mg/kg (RR = 2.39, 95% CrI = 1.00-7.92).
  • Symptomatic Intracranial Hemorrhage (sICH): No significant difference was noted between tenecteplase and alteplase for sICH overall, but tenecteplase 0.25 mg/kg was associated with a lower rate of sICH in elderly patients compared to alteplase 0.9 mg/kg.
  • Significant differences in effectiveness and safety profiles of tenecteplase were observed between Asian and Caucasian patients, with Asian patients exhibiting higher recanalization rates (RR: 1.91, 95% CI: 1.30 to 2.80) but also higher mortality rates (RR: 1.18, 95% CI: 0.87-1.62). Tenecteplase 0.25 mg/kg demonstrated superior safety in elderly patients concerning symptomatic intracranial hemorrhage compared to alteplase 0.9 mg/kg.

Product Monograph / Prescribing Information

Document TitleYearSource
TNKase (tenecteplase) Prescribing Information.2024Genentech, Inc., South San Francisco, CA

Systematic Reviews / Meta-Analyses

Document TitleYearSource
Comparative efficacy and safety among different doses of tenecteplase for acute ischemic stroke: A systematic review and network meta-analysis2024Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National
Tenecteplase versus alteplase for acute ischaemic stroke: a meta-analysis of phase III randomised trials2024Stroke and Vascular Neurology
Intravenous thrombolysis with tenecteplase versus alteplase combined with endovascular treatment of anterior circulation tandem occlusions: A pooled analysis of ETIS and TETRIS2024European Stroke Journal
Tenecteplase for the treatment of acute ischemic stroke in the extended time window: a systematic review and meta-analysis2024Therapeutic Advances in Neurological Disorders
Ethnic Differences in the Safety and Efficacy of Tenecteplase Versus Alteplase for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis2024Journal of Stroke
Tenecteplase versus alteplase for the treatment of acute ischemic stroke: a meta-analysis of randomized controlled trials2024Annals of Medicine
Efficacy and safety of intravenous tenecteplase compared to alteplase before mechanical thrombectomy in acute ischemic stroke: a meta-analysis2024Journal of Neurology
Tenecteplase versus Alteplase in Acute Ischemic Stroke: A Systematic Review and Meta-analysis2024Annals of Neurosciences
Endovascular thrombectomy without versus with different pre-intravenous thrombolysis in acute ischemic stroke: a network meta-analysis of randomized controlled trials2024Frontiers in Neurology
Tenecteplase vs. alteplase for treatment of acute ischemic stroke: A systematic review and meta-analysis of randomized trials2023Frontiers in Neurology
The efficacy and safety of tenecteplase versus alteplase for acute ischemic stroke: an updated systematic review, pairwise, and network meta-analysis of randomized controlled trials2023Journal of Thrombosis and Thrombolysis
Comparative Efficacy and Safety of Thrombolytic Agents for Pulmonary Embolism: A Bayesian Network Meta-Analysis2023Pharmacology
Safety and Efficacy of Tenecteplase and Alteplase in Patients With Tandem Lesion Stroke: A Post Hoc Analysis of the EXTEND-IA TNK Trials2023Neurology
Complications of Intravenous Tenecteplase Versus Alteplase for the Treatment of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis2023Stroke
Different dosing regimens of Tenecteplase in acute ischemic stroke: A network meta-analysis of the clinical evidence2023European Stroke Journal
Different doses of tenecteplase vs. alteplase for acute ischemic stroke within 4.5 hours of symptom onset: a network meta-analysis of randomized controlled trials2023Frontiers in Neurology
Tenecteplase vs. Alteplase for Intravenous Thrombolytic Therapy of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis2023Neurology and Therapy
A Systematic Review of the Efficacy and Safety of Tenecteplase Versus Streptokinase in the Management of Myocardial Infarction in Developing Countries2023Cureus
Tenecteplase, 0.4 mg/kg, in Moderate and Severe Acute Ischemic Stroke: A Pooled Analysis of NOR-TEST and NOR-TEST 2A2023Journal of the American Heart Association
Tenecteplase versus alteplase for patients with acute ischemic stroke: a meta-analysis of randomized controlled trials2023Aging
Short-Term Efficacy Outcomes of Tenecteplase versus Alteplase for Acute Ischemic Stroke: A Meta-Analysis of 5 Randomized Trials2022Neurology India
Safety and Efficacy of Tenecteplase in Older Patients With Large Vessel Occlusion: A Pooled Analysis of the EXTEND-IA TNK Trials2022Neurology
Tenecteplase vs. alteplase for acute ischemic stroke: a systematic review2022International Journal of Emergency Medicine

Clinical Practice Guidelines