Wednesday February 20, 2008
Minocycline in Acute Ischemic Stroke ?

Minocycline is a second-generation derivative of tetracycline that has been shown to have a beneficial neuroprotective effect in animal models of MS (multiple sclerosis), Parkinson's disease, Huntington's disease, and ALS. Also, here has been evidence of minocycline's ability to improve outcomes in an animal model of stroke.

Proposed mechanism of action: Proposed mechanisms of action in minocycline include its antiinflammatory effect, reduction of microglia activation, matrix metalloproteinase reduction, nitric oxide production, and inhabitation of apoptotic cell death.

Clinical study: This was an open-label clinical trial, although the evaluator was blinded.

Number (n) = 152 patients who suffered acute ischemic strokes

Mean age = 67 years

74 patients were randomized to receive 200 mg per day of minocycline orally for five days with a therapeutic window of six to 24 hours after onset of stroke. 77 patients were randomized to receive placebo in the same time window.

The primary outcome: was the NIH Stroke Scale score 90 days after admission to the study.


Results:

• At day 90, NIH Stroke Scale scores were significantly lower for minocycline-treated subjects compared to placebo treated patients
• This difference was already statistically significant by day seven and day 30 of the trial
  
  

Conclusion: The investigators conclude that patients with acute stroke had significantly better outcome with minocycline treatment compared to placebo.

Reference: click to get abstract /article

1. Minocycline Treatment in Acute Stroke: An Open-Label, Evaluator-Blinded Study. Neurology; 2007; 69 (October 2): 1404-1410