Trager Hintze, PharmD, PharmD
Clinical Assistant Professor
University Health System
San Antonio, Texas
Disclosure information not submitted.
Clay Small, PharmD
Clinical Pharmacist
University Health System, United States
Disclosure information not submitted.
Josephine Montgomery, PharmD
Clinical Pharmacist
University Health, United States
Disclosure information not submitted.
Kelly Reveles, PharmD, PhD
Pharmacist
University Health, United States
Disclosure information not submitted.
Shaheryar Hafeez, MD
Assistant Professor
University Health, United States
Disclosure information not submitted.
Colleen Barthol, PharmD, BCPS, BCCCP
Clinical Pharmacist
University Hospital, United States
Disclosure information not submitted.
Title: Amantadine, Modafinil, or Standard Care for Disorders of Consciousness After Traumatic Brain Injury
Introduction: Traumatic brain injury (TBI) is a disruption in normal brain function due to an external force, and a major cause of death and disability worldwide. Many patients following a TBI will have a decreased level of consciousness manifested by a Glasgow Coma Score (GCS) < 15. Amantadine and modafinil have been utilized to promote wakefulness in some neurological disorders; however, a comparison of the two medications in TBI has not been reported. The objective of this study was to compare the effectiveness of amantadine, modafinil, and standard of care (SOC) on the promotion of wakefulness following TBI measured by the change in GCS.
Methods: All TBI patients >18 years from January 1, 2017 to September 31, 2020 who received amantadine, modafinil, or SOC treatments to promote wakefulness were screened for inclusion. The primary outcome measure was change in GCS from admission to discharge. Secondary outcomes included change in GCS from medication initiation to discharge, ICU and hospital length of stay, time to and duration of medication therapy, and adverse drug reactions. Patients in the amantadine and modafinil groups were matched 1:2 with patients who received SOC therapies based on age and TBI severity.
Results: There were 142 patients included in the analysis, with 43, 13, and 86 patients in the amantadine, modafinil, and SOC groups, respectively. Medications were initiated a median of eight days from admission. Patients in the SOC group experienced a greater improvement in GCS (7.5 vs. 6, P=0.006) and shorter hospital length of stay (20 vs. 34 days, P=0.002) compared to amantadine. A change in GCS > 3 from medication initiation to hospital discharge occurred in 46.5% (n=20) of amantadine patients and 53.8% (n=7) of modafinil patients.
Conclusions: In this study, TBI patients did not benefit from amantadine or modafinil compared to SOC therapies, and no differences were found between medication groups, in regards to primary and secondary outcomes. The shorter ICU and hospital length of stay in the SOC group represent both statistically and clinically significant differences. Further studies are warranted to determine if the addition of amantadine or modafinil to the SOC in the weeks following a TBI provides benefit.