Pharmacological management of secondary spinal cord injury

ABSTRACT

Introduction: Secondary spinal cord injury (SCI) sets on immediately after trauma and, despite prompt treatment, may become chronic. SCI is a complex condition and presents numerous challenges to patients and physicians alike, also considering the lack of an approved pharmacological therapy.

Areas covered: This review describes the pathophysiological mechanisms leading to secondary SCI to highlight possible targets for pharmacological therapy. Furthermore, an extensive search of the literature on different databases (PubMed, Google scholar, Embase, and Scopus) and of the current clinical trials (clinicaltrials.gov) was performed to investigate the current outlook for the pharmacological management of SCI. Only drugs with performed or ongoing clinical trials were considered.

Expert opinion: Pharmacological therapy aims to improve motor and sensory function in patients. Overall, drugs are divided into neuroprotective compounds, which aim to limit the damage induced by the pro-inflammatory and pro-apoptotic milieu of SCI, and neuroregenerative drugs, which induce neuronal and axonal regrowth. While many compounds have been trialed with promising results, none has yet completed a stage III trial and has been approved for the pharmacological management of SCI.

KEYWORDS:

• Spinal cord injury
• pathophysiology
• pharmacological therapy
• neuroprotective drugs
• neuroregenerative drugs
• clinical trial

Article highlights

• Secondary spinal cord injury (SCI) begins immediately after trauma, and often leads to chronic SCI

• The main pathophysiological mechanisms involved in secondary SCI are haemorrhage (with ischemia and blood – spinal cord barrier disruption), dysregulation of the immune response, scar formation and lack of repair mechanisms in the central nervous system

• SCI is a complex condition and presents numerous challenges to patients and physicians alike, also considering the lack of an approved pharmacological therapy

• Drugs trialled for the management of secondary SCI are divided into neuroprotective, which limit tissue damage caused by inflammation and excitotoxicity, and neuroregenerative, which aim to enhance neuronal and axonal repair

• So far, no compound has successfully completed a phase III clinical trial or has been approved for the management of SCI

This box summarizes key points contained in the article.

Declaration of interest

The author(s) have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.