title: The effect of intravenous interleukin-1 receptor antagonist on inflammatory mediators in cerebrospinal fluid after subarachnoid haemorrhage: a phase II randomised controlled trial.
abstract: BACKGROUND
  Interleukin-1 (IL-1) is a key mediator of ischaemic brain injury induced by stroke and subarachnoid haemorrhage (SAH). IL-1 receptor antagonist (IL-1Ra) limits brain injury in experimental stroke and reduces plasma inflammatory mediators associated with poor outcome in ischaemic stroke patients. Intravenous (IV) IL-1Ra crosses the blood-brain barrier (BBB) in patients with SAH, to achieve cerebrospinal fluid (CSF) concentrations that are neuroprotective in rats.
  
  
  METHODS
  A small phase II, double-blind, randomised controlled study was carried out across two UK neurosurgical centres with the aim of recruiting 32 patients. Adult patients with aneurysmal SAH, requiring external ventricular drainage (EVD) within 72 hours of ictus, were eligible. Patients were randomised to receive IL-1Ra (500 mg bolus, then a 10 mg/kg/hr infusion for 24 hours) or placebo. Serial samples of CSF and plasma were taken and analysed for inflammatory mediators, with change in CSF IL-6 between 6 and 24 hours as the primary outcome measure.
  
  
  RESULTS
  Six patients received IL-1Ra and seven received placebo. Concentrations of IL-6 in CSF and plasma were reduced by one standard deviation in the IL-1Ra group compared to the placebo group, between 6 and 24 hours, as predicted by the power calculation. This did not reach statistical significance (P = 0.08 and P = 0.06, respectively), since recruitment did not reach the target figure of 32. No adverse or serious adverse events reported were attributable to IL-1Ra.
  
  
  CONCLUSIONS
  IL-1Ra appears safe in SAH patients. The concentration of IL-6 was lowered to the degree expected, in both CSF and plasma for patients treated with IL-1Ra.
authors.forename: Navneet
authors.initials: N
authors.lastname: Singh
authors.affiliation: The University of Manchester Stroke and Vascular Centre, Manchester Academic Health Sciences Centre, Clinical Sciences Building, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK. Steve.Hopkins@manchester.ac.uk.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Hopkins
authors.forename: Sharon
authors.initials: S
authors.lastname: Hulme
authors.forename: James P
authors.initials: JP
authors.lastname: Galea
authors.forename: Margaret
authors.initials: M
authors.lastname: Hoadley
authors.forename: Andy
authors.initials: A
authors.lastname: Vail
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hutchinson
authors.forename: Samantha
authors.initials: S
authors.lastname: Grainger
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Rothwell
authors.forename: Andrew T
authors.initials: AT
authors.lastname: King
authors.forename: Pippa J
authors.initials: PJ
authors.lastname: Tyrrell
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D016207:Cytokines / Q000097:blood / Q000134:cerebrospinal fluid*; D004311:Double-Blind Method; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000097:blood / Q000134:cerebrospinal fluid* / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D016207:Cytokines; D053590:Interleukin 1 Receptor Antagonist Protein