Two trials presented at ESOC 2022 here in Lyon, the TWIST trial (https://vmx.m-anage.com/congrex/esoc2022/en-GB/presentation/344533) and the NOR-TEST2 trial (https://vmx.m-anage.com/congrex/esoc2022/en-GB/presentation/344561), showed that at best tenecteplase has no clinical efficacy benefit over alteplase in acute ischemic stroke and tends toward higher bleeding rates.
This was seen in a large Canadian trial as well (https://vmx.m-anage.com/congrex/esoc2022/en-GB/presentation/344562).
The first two trials also repeated previously suggested observation from smaller trials that tenecteplase has a higher overall sICH rate.
The NOR-TEST2 trial was worrisome in that only moderate-to-severe strokes were included, showing a bias effect due to earlier studies that mainly included only mild strokes.
The message here is that convenience does not equate to efficacy even though we would like it to be!
