Conditions: Ischemic Stroke
Keywords: Stroke Ischemic Stroke Neuroprotective Agents Nootropic Agents Antioxidants Randomized Controlled Trials as Topic Recovery of Function Mexidol Ethylmethylhydroxypyridine Succinate Brain Ischemia Acute Stroke Acute Cerebrovascular Accident Cerebral Stroke Neuroprotection
Allocation: RANDOMIZED | Intervention model: PARALLEL
Enrollment: 150
Healthy volunteers: no

Brief summary:
The purpose of this study is to evaluate the efficacy and safety of long-term sequential therapy with Mexidol® in long-term sequential treatment of patients in the acute and early recovery periods of hemispheric ischemic stroke (IS). This is superiority trial that investigates whether Mexidol® better than placebo.

Detailed description:
In the course of a clinical study involving patients, the efficacy and safety of prolonged sequential therapy with Mexidol® (solution for intravenous and intramuscular administration / coated tablets) were evaluated compared to placebo in patients with hemispheric ischemic stroke during the acute and early recovery periods. The use of Mexidol® (solution for intravenous and intramuscular administration / coated tablets) and placebo (solution for intravenous and intramuscular administration / coated tablets) was conducted against the background of standard baseline therapy.

Throughout the study, both the investigational drug Mexidol® and the placebo, used alongside baseline therapy, were tolerated satisfactorily. In this clinical study, 37 cases of adverse events (AEs) not meeting the criteria for severity were recorded in 28 patients, along with 4 AEs that were categorized as serious adverse events (SAEs) in 4 patients. Most of the registered AEs required appropriate corrective therapy but did not necessitate other medical interventions and resolved by the end of the patient's participation in the study. According to the researchers, in the majority of recorded AEs, the relationship with the investigational drugs was determined to be absent (no relationship).

When comparing the frequency of registration of both individual AEs and SAEs, no statistically significant differences (p \< 0.05) were found in the frequency of AEs/SAEs in patients after taking the investigational drug (Mexidol®) and the comparison drug (placebo). According to the conducted clinical study, the safety profile of Mexidol® remained unchanged and favorable. No new safety signals were recorded during the course of the study.

The primary endpoint is the results of testing using the modified Rankin Scale (mRS) at the end of the therapy course (in both the investigational and control groups). In the overall population of patients included in the efficacy analysis, positive dynamics were observed in both the Mexidol® group and the placebo group (p \< 0.001): a decrease in the mean scores on the scale throughout the study; a statistically significant difference was also identified between the mean scores on the mRS at visit 5 compared to baseline values (visit 1) in both groups. Additionally, at visit 5, a statistically significant difference was observed between the treatment groups (p = 0.04) regarding the total scores on the modified Rankin Scale: the average score for the Mexidol® group was 1.098 points, while for the placebo group, it was 1.46 points. No statistically significant differences between the groups were found at other visits. The assessment of the change in mRS score from baseline (visit 1) to the end of therapy (visit 5) showed statistically significant differences (p = 0.04) between the treatment groups: in the Mexidol® group, the value was 1.098; in the placebo group, it was 1.460.

Thus, Mexidol® demonstrated greater efficacy compared to placebo when used alongside baseline therapy in patients with hemispheric ischemic stroke during the acute and early recovery period based on the primary efficacy criterion, which is the results of testing using the modified Rankin Scale (mRS) at the end of the therapy course.

Furthermore, the study demonstrated the efficacy of Mexidol® therapy concerning several secondary efficacy endpoints. Mexidol® showed greater efficacy in treating hemispheric ischemic stroke compared to placebo when using the specialized scale for this condition-the NIHSS (National Institutes of Health Stroke Scale). In testing using the Beck Depression Inventory (BDI), the efficacy of Mexidol® regarding cognitive disorders in patients who suffered strokes with concurrent diabetes was also identified.

Arms:
arm 1: Participants received Mexidol® solution IV 500 mg daily for 10 days, then Mexidol 125 mg orally 1 tablet 3 times a day for 8 weeks. arm 2: Participants received Mexidol Placebo matching Mexidol solution IV 500 mg daily for 10 days, then Mexidol 125 mg orally 1 tablet 3 times a day for 8 weeks.

Interventions: intervention 1: Mexidol intervention 2: Placebo
Intervention descriptions: intervention 1: 50 mg/ml IV solution, 125 mg tablet intervention 2: Placebo IV solution, Placebo tablet

Protocol document: