Cerebrolysin (porcine brain peptides)

Evidence tier D. The 2020 Cochrane systematic review on cerebrolysin in acute ischaemic stroke pooled randomised controlled trials and found no convincing reduction in mortality or dependency at follow-up. Reviewers rated evidence quality as low because of risk of bias in manufacturer-sponsored trials and heterogeneity of outcomes. The AHA/ASA 2019 acute ischaemic stroke guideline and the ESO 2021 guideline do not list cerebrolysin or other peptide neuroprotectants. Evidence-based acute therapy consists of intravenous thrombolysis with alteplase or tenecteplase within 4.5 hours and mechanical thrombectomy within 6-24 hours in selected large vessel occlusions, followed by secondary prevention with antiplatelets, statins and blood pressure control.

Evidence tier F. Cerebrolysin is not mentioned in the AAN, APA, NICE or EAN dementia guidelines for Alzheimer disease or vascular dementia. A 2017 Cochrane review on cerebrolysin for vascular dementia concluded that data were insufficient to support routine clinical use. Available trials are small, mostly single-centre, sponsored by the manufacturer and report short-term changes on cognitive scales without consistent effects on activities of daily living or institutionalisation. Evidence-based therapy for Alzheimer dementia consists of cholinesterase inhibitors (donepezil, rivastigmine, galantamine) and memantine, which produce modest symptomatic benefit but do not modify disease progression.