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Lashch NU, Kamchatnov PR, Fedorova TN, Muzychuk OA, Khacheva KK, Pizova NV, Malygin AU, Shavlovskaya OA, Fateeva VV, Nikulina KV, Abrosimov АV, Gerasimova YA, Glushkov KS, Lebedeva AV. Efficacy and Safety of Divaza for the Correction of Oxidative Disturbances in Patients with Cerebral Atherosclerosis: A Randomized Controlled Trial. Cerebrovasc Dis 2021; 50:472-482. [PMID: 34044407 DOI: 10.1159/000515233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/10/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of this study was to determine if Divaza, a drug with nootropic and antioxidant effects, was safe and effective for the correction of oxidative disturbances and to stabilize cognitive impairment in patients with cerebral atherosclerosis. STUDY DESIGN The study design consisted of a 12-week multicenter, randomized, double-blind, placebo-controlled, prospective trial in parallel groups. SETTING The setting in which the study was conducted comprised 10 clinical centers across the Russian Federation. INTERVENTIONS Patients were randomized into 2 groups and instructed to take either 2 tablets of the study drug or a placebo 3 times per day in conjunction with basic therapy. OUTCOMES The primary outcome was a change in the average endogenous antioxidant potential after the completion of the study. The blood indicators of the oxidative stress (OS) were analyzed at the baseline and then after 12 weeks of therapy using iron-induced chemiluminescence analysis. The Montreal cognitive assessment test was used as a secondary outcome measure to evaluate cognitive impairment at the end of the study. RESULTS 124 outpatients with a mean age of 60.7 ± 7.6 years were enrolled and randomly assigned to receive Divaza (n = 65) or a placebo (n = 59). An improvement of cognitive function was observed in all patients of the Divaza group at the end of the treatment; this was significantly better than the placebo group (100 [100] vs. 89.5 [89.1]%, respectively, p = 0.0272 [p = 0.0128]). The administration of Divaza restored the activity of the endogenous antioxidant system. The change in the average level of lipoprotein resistance to oxidation after 12 weeks of therapy, compared to the baseline, was significantly higher in the Divaza group (14.8 ± 14.7 [14.8 ± 14.7] seconds latent period vs. 6.4 ± 16.9 [6.9 ± 16.7] seconds in the placebo group (p = 0.007 [p = 0.0107]). CONCLUSIONS Divaza is a safe and effective therapeutic option for attenuating OS and recovery of cognitive impairment in patients with cerebral atherosclerosis.
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Affiliation(s)
- Nataliia U Lashch
- Pirogov Russian National Research Medical University, Moscow, Russian Federation.,Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russian Federation
| | - Pavel R Kamchatnov
- Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | | | | | | | | | | | - Olga A Shavlovskaya
- Autonomous Nonprofit Organization of Higher Education «International University of Restorative Medicine», Moscow, Russian Federation
| | - Victoria V Fateeva
- Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| | - Kseniya V Nikulina
- Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| | | | | | | | - Anna V Lebedeva
- Scientific Research Institute of Healthcare Organization and Medical Management of Moscow Department of Healthcare, State-Financed Institution of Moscow City, Moscow, Russian Federation
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Parfenov VA, Zhivolupov SA, Poverennova IE, Nesterova MV, Ushakova SE, Zhukova NG, Glazunov AB, Nikulina KV, Alexandrov MV, Lapatukhin VG, Zhestikova MG. Treatment of Cognitive Impairment and the Role of Demographic Factors in Disease Progression: The Final Results of the Russian Observational Program "DIAMANT". Eur Neurol 2020; 83:591-601. [PMID: 33202402 DOI: 10.1159/000508184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 04/24/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic cerebral ischemia (CCI) is a form of cerebrovascular disease manifested as a vascular cognitive impairment (VCI). The management of the patients with CCI is determined by a healthy lifestyle and early therapy aimed at correcting and preventing this disease. Divaza is a drug with endothelial protective and nootropic effects. We present the final efficacy and safety analysis of all-Russian, open-label, prospective, observational, multicenter study of Divaza and emphasize the role of demographic and socioeconomic factors in cognitive disorder (CD) progression. METHODS CCI patients (n = 2,583) with or without CD were enrolled. Patients received Divaza (2 tablets 3 times per day for 12 weeks). Montreal Cognitive Assessment (MoCA) testing was required. The change in the mean MoCA score post-treatment was used as the primary endpoint. As the secondary endpoints, the number of patients with a MoCA <26 and ≤17 (dementia); the percentage of patients with a MoCA score improvement in different age groups; the dynamics of mean MoCA score in age groups; and the relationship between CD and sex or regional social/economic factors were assessed. RESULTS Divaza therapy led to a significant improvement: the mean MoCA score was up to 20% higher post-treatment (Wilcoxon test, p < 0.0001 vs. baseline). The number of participants with MoCA ≥26 increased by 33.6%. The number of patients with dementia was 4.1 times less after therapy (p < 0.00001 vs. baseline). Divaza improved cognitive functions of patients in each age group. Findings demonstrate that regional socioeconomic factors contribute to CD development and severity. The observed divergence between sexes was a result of a larger number of women enrolled. The study confirmed the safety of Divaza. CONCLUSIONS In the study, we observed the efficacy of Divaza for the treatment of CD: a therapy contributed to an increase in the mean MoCA score and the positive dynamics in the number of patients with cognitive improvement.
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Affiliation(s)
- Vladimir Anatolyevich Parfenov
- Neurology and Neurosurgery Department, Medical Faculty, I.M. Sechenov Moscow State University, Moscow, Russian Federation
| | - Sergey Anatolyevich Zhivolupov
- Department of Neurological diseases, Military Medical Academy, Kirov Russian Ministry of Defense, Saint-Petersburg, Russian Federation
| | | | - Marina Valentinovna Nesterova
- Department of Neurological Diseases and Neurosurgery, Ural State Medical, Department of Family Medicine, Ural State Medical, Ekaterinburg, Russian Federation.,Laboratory of Сerebral Circulation, Sverdlovsk Regional War Veterans Hospital, Ekaterinburg, Russian Federation
| | | | - Natalia Grigoryevna Zhukova
- Department of Neurological Diseases and Neurosurgery, Siberian State Medical University, Tomsk, Russian Federation
| | | | | | | | - Vladislav Gennadyevich Lapatukhin
- Department of Neurology, Russian Medical Academy of Professional Medical Education of the Ministry of Health of the Russian Federation (RMANPO of the Ministry of Health of Russia), Penza, Russian Federation
| | - Marina Grigoryevna Zhestikova
- Department of Neurology, Manual Therapy and Reflexology, Novokuznetsk State University of Professional Medical Education (RMANPO of the Ministry of Health of Russia), Novokuznetsk, Russian Federation
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Fateeva VV. [Pathogenesis of endothelial dysfunction in cerebral atherosclerosis and their correction]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 117:67-70. [PMID: 29376986 DOI: 10.17116/jnevro201711712167-70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The authors review the studies on oxidative stress in the pathogenesis of cerebrovascular diseases (CVD) and highlight a contribution of endothelial dysfunction to the CVD development. Own experience of using divasa in patients of old and very old age with chronic CVD comorbid to cerebral atherosclerosis is described.
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Affiliation(s)
- V V Fateeva
- Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
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Parfenov VA, Ostroumova OD, Ostroumova TM, Kochetkov AI, Fateeva VV, Khacheva KK, Khakimova GR, Epstein OI. Vascular cognitive impairment: pathophysiological mechanisms, insights into structural basis, and perspectives in specific treatments. Neuropsychiatr Dis Treat 2019; 15:1381-1402. [PMID: 31190841 PMCID: PMC6535085 DOI: 10.2147/ndt.s197032] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/14/2019] [Indexed: 01/19/2023] Open
Abstract
Vascular cognitive impairment (VCI) and vascular dementia are the most common forms of cognitive disorder associated with cerebrovascular disease and related to increased morbidity and mortality among the older population. Growing evidence suggests the contribution of blood-pressure variability, cardiac arrhythmia, hyperactivation of the renin-angiotensin-aldosterone system, endothelial dysfunction, vascular remodeling and stiffness, different angiopathies, neural tissue homeostasis, and systemic metabolic disorders to the pathophysiology of VCI. In this review, we focus on factors contributing to cerebrovascular disease, neurovascular unit alterations, and novel approaches to cognitive improvement in patients with cognitive decline. One of the important factors associated with the neuronal causes of VCI is the S100B protein, which can affect the expression of cytokines in the brain, support homeostasis, and regulate processes of differentiation, repair, and apoptosis of the nervous tissue. Since the pathological basis of VCI is complex and diverse, treatment affecting the mechanisms of cognitive disorders should be developed. The prospective role of a novel complex drug consisting of released-active antibodies to S100 and to endothelial NO synthase in VCI treatment is highlighted.
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Affiliation(s)
- Vladimir A Parfenov
- Department of Neurology, Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| | - Olga D Ostroumova
- Laboratory of Clinical Pharmacology and therapy, Federal State Budgetary Educational Institution of Higher Education "N.I. Pirogov Russian National Research Medical University" of the Ministry of Health of the Russian Federation, Russian Clinical and Research Center of Gerontology, Moscow, Russia.,Department of Clinical Pharmacology, Internal Medicine and Propaedeutics I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Tatiana M Ostroumova
- Department of Neurology, Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation
| | - Alexey I Kochetkov
- Laboratory of Clinical Pharmacology and therapy, Federal State Budgetary Educational Institution of Higher Education "N.I. Pirogov Russian National Research Medical University" of the Ministry of Health of the Russian Federation, Russian Clinical and Research Center of Gerontology, Moscow, Russia
| | - Victoria V Fateeva
- Medical Information Department, OOO NPF Materia Medica Holding, Moscow, Russian Federation
| | - Kristina K Khacheva
- Medical Information Department, OOO NPF Materia Medica Holding, Moscow, Russian Federation
| | - Gulnara R Khakimova
- Research and Analytical Division of Scientific Research and Development Department, Moscow, Russian Federation
| | - Oleg I Epstein
- Laboratory of Physiologicaly Active Substances, Department of Molecular and Cellular Pathophysiology, Research Institute of General Pathology and Pathophysiology, Moscow, Russian Federation
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Parfenov VA, Zhivolupov SA, Nikulina KV, Poverennova IE, Lapatuhin VG, Zhestikova MG, Zhukova NG, Glazunov AB. [Diagnosis and treatment of cognitive impairment in patients with chronic cerebral ischemia: the results of observational Russian program DIAMANT]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:15-23. [PMID: 30040796 DOI: 10.17116/jnevro20181186115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIM To investigate the efficacy of divaza in outpatients with cognitive disorders and chronic brain ischemia (CBI). MATERIAL AND METHODS The non-interventional observational program included the data of 2583 outpatients with CBI from 30 cities (8 federal okrugs of the Russian Federation) who were on outpatient neurological treatment and received divaza in a dose of 2 tablets three times a day from Oct 2016 to Jan 2017. Cognitive functions were evaluated using the MoCA scale before and after 3 months of treatment. RESULTS AND CONCLUSION Cognitive disorders were identified in 90.7% of patients (<26 MoCA scores). After treatment, the mean MoCA score increased from 19.58±5.13 to 23.99±4.21 (p<0.0001), the number of patients with normal cognitive functions rate (≥26 scores) increased from 9.3 to 41.3%, the number of patients with marked cognitive impairment decreased. The drug was well-tolerated by old and very old patients, adverse events were observed rarely (0.6% of cases). The majority of doctors (88.4%) noticed the effect of divaza as significant improvement or improvement, and 89.6% of patients valued the effect to be excellent or good. The use of divaza, the drug with endothelioprotective and nootropic effects, is pathogenetically justified and promising in patients with cognitive disorders of vascular etiology.
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Affiliation(s)
- V A Parfenov
- Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | | | - K V Nikulina
- OOO 'NPF "Materia Medica Holding"', Moscow, Russia
| | | | - V G Lapatuhin
- Penza Institute of Improvement of Doctors, Penza, Russia
| | - M G Zhestikova
- Novokuznetsk State Institute of Postgraduate Medicine, Novokuznetsk, Russia
| | - N G Zhukova
- Siberian State Medical University, Tomsk, Russia
| | - A B Glazunov
- Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
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