Cytoflavin in the Complex Rehabilitation of Stroke Patients

Study Overview
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Brief Summary
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It is known that the acute period of stroke occurs is accompanied by oxidative stress, when intense generation of reactive oxygen species (ROS) have a toxic effect, which causes oxidative degradation of proteins, lipids, nucleic acids. Antioxidants may have a positive effect on the processes of reparation, remodeling and neuroplasticity, thus improving the effectiveness of post-stroke rehabilitation. The adjunctive use of drug therapy that improves neuroplasticity may promote accelerated motor learning, which underlies the effects of exercise therapy and physical therapy, speech therapy, and sessions with a psychologist or occupational therapist. CYTOFLAVIN® is a combination of succinic acid, riboflavin, nicotinamide and inosine (riboxin) which has antihypoxic and antioxidant effects. The study hypothetizes that this neurometabolic drug will facilitate learning in stroke survivors and help to acquire new cognitive or motor skills necessary for daily living. The study will be conducted in two parallel groups of stroke survivors: the experimental group will be treated with Cytoflavin along with ohysical rehabilitation, the control group will receive standard rehabilitation course.

Official Title
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A Multicenter, Double-blind, Placebo-controlled, Randomized Study of the Efficacy and Safety of Sequential Therapy With CYTOFLAVIN® (NTFF POLYSAN, Russia), Solution for Intravenous Infusion and Enteric-coated Tablets, in the Complex Rehabilitation of Patients With Acute Stroke

Conditions
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Stroke

Intervention / Treatment
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* Drug: Cytoflavin (Inosine + Nicotinamide + Riboflavin + Succinic Acid)
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Signed Patient informed consent form Men and women aged 40 to 80, inclusive. Ischemic stroke in the carotid area, or hemorrhagic stroke in the cerebral hemispheres, occurred in the previous 14-90 days before screening. Acute neuroimaging data (CT and/or MRI) do not contradict the clinical and topical diagnosis of stroke. The presence of a measurable neurological deficit in the motor or sensory area. Availability of rehabilitation potential, which is assessed by the specialists of the multidisciplinary team Modified Rankin score 3-4. The possibility to visit outpatient rehabilitation at the research center. Ability to understand and comply with protocol requirements. For women: consent to use reliable methods of contraception or absent reproductive potential. For men: consent to the use of adequate methods of contraception, or complete abstinence from sexual activity for the period of the study, or absent reproductive potential. Exclusion Criteria: Known hypersensitivity to any component of the study drug Severe visual and hearing impairments that prevent the implementation of study procedures. Severe spasticity (scored 3-4 by Ashworth scale). Impaired swallowing, which does not allow taking drugs orally. Communication deficit that does not allow the patient to fulfill the conditions of the study protocol (including total aphasia). The presence of contraindications to complex rehabilitation in a hospital (lack of rehabilitation potential, somatic diseases that prevent a complex of rehabilitation measures). Aneurysmal subarachnoid hemorrhage. Previous (before the actual ictus) stroke with residual neurological deficit. Disability is primarily not attributed to the last stroke Severe renal failure Severe liver failure End stage of other chronic incurable diseases. Decompensated diabetes mellitus. History of cancer, mental illness, HIV infection, syphilis, tuberculosis, alcohol, drug or drug addiction. Established diagnosis of a mental or neurodegenerative disease Constant use of psychotropic drugs (neuroleptics, tranquilizers, antidepressants) or nootropic drugs in the previous 3 months before the patient was included in the study, except for stroke treatment in acute hospital. Alcohol or drug addiction 19. Pregnancy, lactation.

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cytoflavin<br> | Drug: Cytoflavin (Inosine + Nicotinamide + Riboflavin + Succinic Acid)<br>* Cytoflavin (Inosine + Nicotinamide + Riboflavin + Succinic Acid), 20 ml (two ampoules of 10 ml each) once a day intravenously in a dilution of 200 ml of 0.9% sodium chloride solution at a rate 3-4 ml/min, for 15 days + Cytoflavin ((Inosine + Nicotinamide + Riboflavin + Succinic Acid), 2 tablets 2 times a day, for 25 days<br>|
| Placebo Comparator: Placebo<br> | Drug: Placebo<br>* Placebo, 20 ml (two ampoules of 10 ml each) once a day intravenously in a dilution of 200 ml of 0.9% sodium chloride solution at a rate 3-4 ml / min, for 15 days + Placebo, 2 tablets 2 times a day, for 25 days<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of performance | Change at the performance subscale (range 0-10, higher=better) of Canadian Occupational Performance Measure (COPM) score after completion of therapy compared to baseline | 40 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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stroke rehabilitation