Multifunctional actions of approved and candidate stroke drugs.
Ischemic stroke causes brain damage by multiple pathways. Previous stroke trials have demonstrated that drugs targeting one or only a few of these pathways fail to improve clinical outcome after stroke. Drugs with multimodal actions have been suggested to overcome this challenge. In this review, we describe the mechanisms of action of agents approved for secondary prevention of ischemic stroke, such as antiplatelet, antihypertensive, and lipid-lowering drugs. These drugs exhibit considerable properties beyond their classical mechanisms, including neuroprotective and neuroregenerative properties. In addition, candidate stroke drugs currently studied in clinical phase III trials are described. Among these, albumin, hematopoietic growth factors, and citicoline have been identified as promising agents with multiple mechanisms. These drugs offer hope that additional treatment options for the acute phase after a stroke will become available in the near future.
Minnerup
Jens
J
Department of Neurology, University of Münster, Albert-Schweitzer-Strasse 33, 48149 Münster, Germany.
Schäbitz
Wolf-Rüdiger
WR
D000418:Albumins / Q000627:therapeutic use; D000818:Animals; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002545:Brain Ischemia / Q000188:drug therapy*; D000077144:Clopidogrel; D003566:Cytidine Diphosphate Choline / Q000627:therapeutic use; D004176:Dipyridamole / Q000627:therapeutic use; D004921:Erythropoietin / Q000627:therapeutic use; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D020521:Stroke / Q000188:drug therapy* / Q000517:prevention & control; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
D000418:Albumins; D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents; D018696:Neuroprotective Agents; D010975:Platelet Aggregation Inhibitors; D004921:Erythropoietin; D016179:Granulocyte Colony-Stimulating Factor; D003566:Cytidine Diphosphate Choline; D004176:Dipyridamole; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin