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ARTICLES: Y. Lampl, M. Boaz, R. Gilad, M. Lorberboym, R. Dabby, A. Rapoport, M. Anca-Hershkowitz, and M. Sadeh Minocycline treatment in acute stroke: An open-label, evaluator-blinded study Neurology 2007; 69: 1404-1410 [Abstract] [Full text] [PDF]

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Minocycline treatment in acute stroke: An open-label, evaluator-blinded study

Wolf-R. Schäbitz, Armin Schneider, Rico Laage of Sygnis Bioscience, INF 400, 69120 Heidelberg, Germany   (5 March 2008)

Reply from the authors

Yair Lampl, MD, Mona Boaz M.Sc   (5 March 2008)

Minocycline treatment in acute stroke: An open-label, evaluator-blinded study 5 March 2008
Wolf-R. Schäbitz, Dept. of Neurology, University of Münster Albert-Schweitzer-str.33, 48149 Münster, Germany, Armin Schneider, Rico Laage of Sygnis Bioscience, INF 400, 69120 Heidelberg, Germany Send Correspondence to journal: Re: Minocycline treatment in acute stroke: An open-label, evaluator-blinded study schabitz{at}uni-muenster.de Wolf-R. Schäbitz, et al.	Lampl et al. studied minocycline as a proposed treatment for stroke and neurodegenerative diseases. [1] We would like to consider some of the design aspects of the study that may have affected the outcome. This was a comparatively large study (152 patients) so it would have been difficult to organize. However, the authors should have attempted to completely blind treatment, especially since minocycline was given orally. This would have allowed them to draw more substantial conclusions from this large patient number as to the effects of minocycline. Second, the proportion of lacunar strokes in the study population is relatively high—around 30%. In Table 1 (bottom line), it is incorrectly noted as 8.5%. These infarcts have a high but unpredictable tendency to improve rapidly, and likely distort statistical interpretations in stroke studies. [2] In addition, Lampl et al. show the improvement in mRS occurred within the first 72 hours after stroke onset. It would be interesting to see a subgroup analysis on the lacunar stroke patient group. References 1. Lampl Y, Boaz M, Gilad R et al. Minocycline treatment in acute stroke: An open-label, evaulator-blinded study. Neurology 2007;69:1404-1410. 2. Savitz SI, Fisher M. Future of neuroprotection for acute stroke: In the aftermath of the SAINT trials. Ann Neurol 2007, 61:396-402. Disclosure: The authors report no conflicts of interest.
Reply from the authors 5 March 2008
Yair Lampl, MD, Edith Wolfson Medical Center Tel Aviv University, Israel, Mona Boaz M.Sc Send Correspondence to journal: Re: Reply from the authors yemimala{at}gmail.com Yair Lampl, MD, et al.	We thank Schabitz et al. for their comments. The percentage of patients that we reported with lacunar stroke is relatively higher than in other studies. This feature can be explained by the relative low NIHSS score which was an inclusion criterion for the study. We agree that a double-blind, placebo-controlled study is necessary for confirming the results, and this point was mentioned in the Discussion of the article. The study's relatively small number of patients with lacunar infarctions prevented us from conducting a meaningful subgroup analysis. However, it would be interesting to examine minocycline treatment in this type of stroke patient in an adequately powered study design. Disclosure: The authors report no conflicts of interest.