Preliminary efficacy report of a novel thrombolytic agent for acute ischaemic stroke within a 5-hour window.
BACKGROUND
Adopting thrombolytic therapy with tissue plasminogen activator (tPA) in clinical practice presents many challenges. One major factor is the restrictive time window of 0-3 hours after symptom onset, for the commencement of treatment.


OBJECTIVE
To test the efficacy of a newly developed plasminogen activator (human tissue urokinase type plasminogen activator [HTUPA]) for the treatment of acute ischaemic stroke within 5 hours of symptom onset.


METHODS
An open-label, dose escalation trial. The initial dose was 0.3 mg/kg and could be increased or decreased depending on tolerability.


METHODS
Three teaching hospitals in Taiwan.


METHODS
Thirty-three patients who presented with National Institute of Health Stroke Scale (NIHSS) scores of between 9 and 20, who had evidence of ischaemic stroke confirmed by CT.


METHODS
Efficacy was assessed by the NIHSS, the Modified Rankin Scale (MRS), the Barthel Index and the Glasgow Outcome Scale. Preliminary efficacy endpoints included major neurological improvement at 24 hours and favourable outcome at 90 days after administration of HTUPA.


RESULTS
Of the 33 patients who received HTUPA, 29 received 0.3 mg/kg, 3 received 0.35 mg/kg and 1 received 0.4 mg/kg. Major neurological improvement, defined as improvement of > or =4 points on the NIHSS 24 hours after treatment, was observed in 45% of all patients treated (15/33) and in 48% (14/29) of those treated with 0.3 mg/kg. Ninety days after symptom onset, in those who received HTUPA 0.3 mg/kg, the proportion of patients with a favourable outcome was 34% on the NIHSS (< or =1), 45% on the MRS (0 or 1), 41% on the Barthel Index (> or =95) and 45% on the Glasgow Outcome Scale (1). Eighty six percent of the patients treated with 0.3 mg/kg within 0-3 hours of symptom onset reached scores of 0-1 on both the NIHSS and the MRS.


CONCLUSIONS
Approximately 50% of patients treated with HTUPA 0.3 mg/kg within a 5-hour window after symptom onset experienced major neurological improvement within 24 hours of drug administration. Thrombolytic agents, in this case HTUPA, may be suitable for Taiwanese or Asian patients with acute ischaemic stroke who meet the inclusion criteria.
Chao
A-Ching
AC
Department of Neurology, Kaohsiung Medical University and Hospital, Kaohsiung, Taiwan.
Teng
Michael Mu-Huo
MM
Chung
Chih-Ping
CP
Weng
Hsing-Yu
HY
Chen
Yen-Yu
YY
Yang
Fu-Yi
FY
Wang
Lee-Min
LM
Hu
Han-Hwa
HH
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D002543:Cerebral Hemorrhage / Q000139:chemically induced; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*
D014568:Urokinase-Type Plasminogen Activator