Other neuroprotective therapies on trial in acute stroke.
New neuroprotective agents on trial may potentially offer benefit to stroke patients without the associated hemorrhagic risk of thrombolytic therapy. Clinical investigation of these drugs has been designed to obtain the highest probability of success, or concentrates on the salvageable ischemic brain and use infarct growth on MRI as a surrogate end-point. Nine substances in 10 trials are currently being tested in three therapeutical strategies in patients with acute ischemic stroke. These strategies focus on: (1) the optimal management of serum glucose with the infusion of glucose, insulin and potassium to induce and maintain euglycemia; (2) the modulation of the inflammatory response with recombinant human interferon-beta(1a), and (3) interfering with the ischemic cascade using magnesium, albumin, the metal iron chelator DP-b99, the AMPA receptor antagonist zonampanel, the serotonin agonists repinotan and piclozotan, the free radical scavenger cerovive, and the membrane modulator citicoline. Future directions should develop neuroprotective compounds that are safe and well tolerated, are effective in a broad range of patients and can be used with or without rt-PA.
Ferro
José M
JM
Department of Neurosciences and Mental Health, Hospital de Santa Maria, Lisboa, Portugal. jmferro@fm.ul.pt
Dávalos
Antoni
A
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001557:Benzenesulfonates / Q000627:therapeutic use; D004338:Drug Combinations; D016166:Free Radical Scavengers / Q000627:therapeutic use*; D005947:Glucose / Q000627:therapeutic use; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000628:therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D000068556:Interferon beta-1a; D016899:Interferon-beta / Q000235:genetics / Q000627:therapeutic use; D018696:Neuroprotective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D011188:Potassium / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000009:adverse effects; D020521:Stroke / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000235:genetics
D000893:Anti-Inflammatory Agents; D001557:Benzenesulfonates; D004338:Drug Combinations; D016166:Free Radical Scavengers; D007004:Hypoglycemic Agents; D007328:Insulin; D018696:Neuroprotective Agents; D011994:Recombinant Proteins; D016899:Interferon-beta; C120851:disufenton sodium; D010959:Tissue Plasminogen Activator; D005947:Glucose; D011188:Potassium; D000068556:Interferon beta-1a