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Phase I and Phase II Therapies for Acute Ischemic Stroke: An Update on Currently Studied Drugs in Clinical Research. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4863079. [PMID: 28286764 PMCID: PMC5329656 DOI: 10.1155/2017/4863079] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/23/2016] [Indexed: 02/06/2023]
Abstract
Acute ischemic stroke is a devastating cause of death and disability, consequences of which depend on the time from ischemia onset to treatment, the affected brain region, and its size. The main targets of ischemic stroke therapy aim to restore tissue perfusion in the ischemic penumbra in order to decrease the total infarct area by maintaining blood flow. Advances in research of pathological process and pathways during acute ischemia have resulted in improvement of new treatment strategies apart from restoring perfusion. Additionally, limiting the injury severity by manipulating the molecular mechanisms during ischemia has become a promising approach, especially in animal research. The purpose of this article is to review completed and ongoing phases I and II trials for the treatment of acute ischemic stroke, reviewing studies on antithrombotic, thrombolytic, neuroprotective, and antineuroinflammatory drugs that may translate into more effective treatments.
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Huang J, Lin Z, Wang Q, Liu F, Liu J, Fang Y, Chen S, Zhou X, Hong W, Wu J, Madrigal-Mora N, Zheng G, Yang S, Tao J, Chen L. The effect of a therapeutic regimen of Traditional Chinese Medicine rehabilitation for post-stroke cognitive impairment: study protocol for a randomized controlled trial. Trials 2015; 16:272. [PMID: 26077459 PMCID: PMC4485558 DOI: 10.1186/s13063-015-0795-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 06/05/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Post-stroke cognitive impairment (PSCI) lessens quality of life, restricts the rehabilitation of stroke, and increases the social and economic burden stroke imposes on patients and their families. Therefore effective treatment is of paramount importance. However, the treatment of PSCI is very limited. The primary aim of this protocol is to propose a lower cost and more effective therapy, and to confirm the long-term effectiveness of a therapeutic regimen of Traditional Chinese Medicine (TCM) rehabilitation for PSCI. METHODS/DESIGN A prospective, multicenter, large sample, randomized controlled trial will be conducted. A total of 416 eligible patients will be recruited from seven inpatient and outpatient stroke rehabilitation units and randomly allocated into a therapeutic regimen of TCM rehabilitation group or cognitive training (CT) control group. The intervention period of both groups will last 12 weeks (30 minutes per day, five days per week). Primary and secondary outcomes will be measured at baseline, 12 weeks (at the end of the intervention), and 36 weeks (after the 24-week follow-up period). DISCUSSION This protocol presents an objective design of a multicenter, large sample, randomized controlled trial that aims to put forward a lower cost and more effective therapy, and confirm the long-term effectiveness of a therapeutic regimen of TCM rehabilitation for PSCI through subjective and objective assessments, as well as highlight its economic advantages. TRIAL REGISTRATION This trial was registered with the Chinese Clinical Trial Registry (identifier: ChiCTR-TRC-14004872 ) on 23 June 2014.
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Affiliation(s)
- Jia Huang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, No. 1 Huatuo Road Shangjie Minhou, Fuzhou, 350122, China. .,Fujian Key Laboratory of Exercise Rehabilitation, No. 282 WUSI Road, Gulou, Fuzhou, 350003, China. .,National Rehabilitation Research Center of Traditional Chinese Medicine, No. 1 Huatuo Road Shangjie Minhou, Fuzhou, 350122, China.
| | - Zhengkun Lin
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, No. 1 Huatuo Road Shangjie Minhou, Fuzhou, 350122, China.
| | - Qin Wang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, No. 1 Huatuo Road Shangjie Minhou, Fuzhou, 350122, China.
| | - Feiwen Liu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, No. 1 Huatuo Road Shangjie Minhou, Fuzhou, 350122, China.
| | - Jiao Liu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, No. 1 Huatuo Road Shangjie Minhou, Fuzhou, 350122, China.
| | - Yunhua Fang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, No. 1 Huatuo Road Shangjie Minhou, Fuzhou, 350122, China.
| | - Shanjia Chen
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, No. 1 Huatuo Road Shangjie Minhou, Fuzhou, 350122, China.
| | - Xiaoxuan Zhou
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, No. 1 Huatuo Road Shangjie Minhou, Fuzhou, 350122, China.
| | - Wenjun Hong
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, No. 1 Huatuo Road Shangjie Minhou, Fuzhou, 350122, China.
| | - Jinsong Wu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, No. 1 Huatuo Road Shangjie Minhou, Fuzhou, 350122, China.
| | - Natalia Madrigal-Mora
- Friedrich-Alexander University Erlangen-Nuremberg, Schlossplatz 4, 91054, Erlangen, Germany.
| | - Guohua Zheng
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, No. 1 Huatuo Road Shangjie Minhou, Fuzhou, 350122, China.
| | - Shanli Yang
- Fujian University of Traditional Chinese Medicine Subsidiary Rehabilitation Hospital, No. 282 WUSI Road, Gulou, Fuzhou, 350003, China.
| | - Jing Tao
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, No. 1 Huatuo Road Shangjie Minhou, Fuzhou, 350122, China. .,Fujian Key Laboratory of Exercise Rehabilitation, No. 282 WUSI Road, Gulou, Fuzhou, 350003, China. .,National Rehabilitation Research Center of Traditional Chinese Medicine, No. 1 Huatuo Road Shangjie Minhou, Fuzhou, 350122, China.
| | - Lidian Chen
- Fujian Key Laboratory of Exercise Rehabilitation, No. 282 WUSI Road, Gulou, Fuzhou, 350003, China. .,National Rehabilitation Research Center of Traditional Chinese Medicine, No. 1 Huatuo Road Shangjie Minhou, Fuzhou, 350122, China. .,Fujian University of Traditional Chinese Medicine, No. 1 Huatuo Road Shangjie Minhou, Fuzhou, 350122, China.
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Barrett KM, Brott TG, Brown RD, Carter RE, Geske JR, Graff-Radford NR, McNeil RB, Meschia JF. Enhancing recovery after acute ischemic stroke with donepezil as an adjuvant therapy to standard medical care: results of a phase IIA clinical trial. J Stroke Cerebrovasc Dis 2011; 20:177-82. [PMID: 21295494 DOI: 10.1016/j.jstrokecerebrovasdis.2010.12.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 12/17/2010] [Accepted: 12/21/2010] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Our aim was to assess the safety, tolerability, and efficacy signal of early donepezil administration with regard to enhancing recovery in a diverse acute ischemic stroke population. METHODS This was a multicenter, single-arm, National Institute of Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator trial-controlled, modified 2-stage adaptive clinical trial set in 2 tertiary care hospitals in the United States. Adults with ischemic stroke treated within 24 hours after onset of symptoms were included. The intervention studied was donepezil 5 mg/day for 30 days, followed by an increase to 10 mg/day for 60 days. Our main outcome measures included treatment-related adverse events and side effects. The primary favorable outcome was a 90-day National Institutes of Health Stroke Scale (NIHSS) score ≤1. Neurologic, cognitive, functional, and psychological outcomes were assessed longitudinally. RESULTS Thirty-three adults (median age 66 years; 59% female; 39% received tissue plasminogen activator) initiated treatment with donepezil. There were no treatment-related serious adverse events. Three participants (9%) discontinued donepezil because of side effects and 3 participants (9%) required a reduction to 5 mg/day after titration to 10 mg/day. Fifteen participants (45%) had a favorable outcome (NIHSS score ≤1 at day 90), and the study met prespecified criteria for continuing to a randomized trial (P < .10). Statistically significant improvements from baseline were observed with several secondary cognitive measures, including the Trail Making Tests and Mini-Mental State Exam (P < .01 for both). CONCLUSIONS Adjuvant donepezil therapy initiated within 24 hours of acute ischemic stroke was safe and tolerated at 5 mg/day to 10 mg/day. The study met a priori criteria to move forward with a randomized clinical trial.
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Affiliation(s)
- Kevin M Barrett
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
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