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Minocycline treatment in acute stroke

An open-label, evaluator-blinded study

From the Departments of Neurology (Y.L., R.G., R.D., A.R., M.A.-H., M.S.) and Nuclear Medicine (M.L.) and Epidemiology Unit (M.B.), Edith Wolfson Medical Center, Holon and Sackler Faculty of Medicine, Tel Aviv University, Israel.

Address correspondence and reprint requests to Dr. Y. Lampl, Department of Neurology, Edith Wolfson Medical Center, Holon 58100, Israel y_lampl{at}hotmail.com

Background: Ischemic animal model studies have shown a neuroprotective effect of minocycline.

Objective: To analyze the effect of minocycline treatment in human acute ischemic stroke.

Methods: We performed an open-label, evaluator-blinded study. Minocycline at a dosage of 200 mg was administered orally for 5 days. The therapeutic window of time was 6 to 24 hours after onset of stroke. Data from NIH Stroke Scale (NIHSS), modified Rankin Scale (mRS), and Barthel Index (BI) were evaluated. The primary objective was to compare changes from baseline to day 90 in NIHSS in the minocycline group vs placebo.

Results: One hundred fifty-two patients were included in the study. Seventy-four patients received minocycline treatment, and 77 received placebo. NIHSS and mRS were significantly lower and BI scores were significantly higher in minocycline-treated patients. This pattern was already apparent on day 7 and day 30 of follow-up. Deaths, myocardial infarctions, recurrent strokes, and hemorrhagic transformations during follow-up did not differ by treatment group.

Conclusions: Patients with acute stroke had significantly better outcome with minocycline treatment compared with placebo. The findings suggest a potential benefit of minocycline in acute ischemic stroke.

GLOSSARY: ACE = angiotensin-converting enzyme; ACEI = angiotensin-converting enzyme inhibitor; BI = Barthel Index; mRS = modified Rankin Scale; NIHSS = NIH Stroke Scale; PUD = peptic ulcer disease; SU = sulfonylurea.

Received May 2, 2006. Accepted in final form April 27, 2007.

Disclosure: The authors report no conflicts of interest.

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