Minocycline for acute stroke treatment: a systematic review and meta-analysis of randomized clinical trials.

MedStar author(s):
Citation: Journal of Neurology. 265(8):1871-1879, 2018 Aug.PMID: 29948247Institution: MedStar Washington Hospital CenterDepartment: Medicine/Critical Care MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleYear: 2018Local holdings: Available online from MWHC library: 1997 - presentISSN:
  • 0340-5354
Name of journal: Journal of neurologyAbstract: BACKGROUND: Various randomized-controlled clinical trials (RCTs) have investigated the neuroprotective role of minocycline in acute ischemic stroke (AIS) or acute intracerebral hemorrhage (ICH) patients. We sought to consolidate and investigate the efficacy and safety of minocycline in patients with acute stroke.CONCLUSIONS: Although data is limited, minocycline demonstrated efficacy and seems a promising neuroprotective agent in acute stroke patients, especially in AIS subgroup. Further RCTs are needed to evaluate the efficacy and safety of minocycline among ICH patients.METHODS: Literature search spanned through November 30, 2017 across major databases to identify all RCTs that reported following efficacy outcomes among acute stroke patients treated with minocycline vs. placebo: National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), and modified Rankin Scale (mRS) scores. Additional safety, neuroimaging and biochemical endpoints were extracted. We pooled mean differences (MD) and risk ratios (RR) from RCTs using random-effects models.RESULTS: We identified 7 RCTs comprising a total of 426 patients. Of these, additional unpublished data was obtained on contacting corresponding authors of 5 RCTs. In pooled analysis, minocycline demonstrated a favorable trend towards 3-month functional independence (mRS-scores of 0-2) (RR=1.31; 95% CI 0.98-1.74, p=0.06) and 3-month BI (MD=6.92; 95% CI -0.92, 14.75; p=0.08). In AIS subgroup, minocycline was associated with higher rates of 3-month mRS-scores of 0-2 (RR=1.59; 95% CI 1.19-2.12, p=0.002; I<sup>2</sup>=58%) and 3-month BI (MD=12.37; 95% CI 5.60, 19.14, p=0.0003; I<sup>2</sup>=47%), whereas reduced the 3-month NIHSS (MD -2.84; 95% CI -5.55, -0.13; p=0.04; I<sup>2</sup>=86%). Minocycline administration was not associated with an increased risk of mortality, recurrent stroke, myocardial infarction and hemorrhagic conversion.All authors: Alexandrov AV, Blacker D, Chang JJ, Goyal N, Hernandez AV, Khunger A, Malhotra K, Pasupuleti V, Switzer JA, Tsivgoulis GFiscal year: FY2018Fiscal year of original publication: FY2018Digital Object Identifier: Date added to catalog: 2018-07-06
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 29948247 Available 29948247

Available online from MWHC library: 1997 - present

BACKGROUND: Various randomized-controlled clinical trials (RCTs) have investigated the neuroprotective role of minocycline in acute ischemic stroke (AIS) or acute intracerebral hemorrhage (ICH) patients. We sought to consolidate and investigate the efficacy and safety of minocycline in patients with acute stroke.

CONCLUSIONS: Although data is limited, minocycline demonstrated efficacy and seems a promising neuroprotective agent in acute stroke patients, especially in AIS subgroup. Further RCTs are needed to evaluate the efficacy and safety of minocycline among ICH patients.

METHODS: Literature search spanned through November 30, 2017 across major databases to identify all RCTs that reported following efficacy outcomes among acute stroke patients treated with minocycline vs. placebo: National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), and modified Rankin Scale (mRS) scores. Additional safety, neuroimaging and biochemical endpoints were extracted. We pooled mean differences (MD) and risk ratios (RR) from RCTs using random-effects models.

RESULTS: We identified 7 RCTs comprising a total of 426 patients. Of these, additional unpublished data was obtained on contacting corresponding authors of 5 RCTs. In pooled analysis, minocycline demonstrated a favorable trend towards 3-month functional independence (mRS-scores of 0-2) (RR=1.31; 95% CI 0.98-1.74, p=0.06) and 3-month BI (MD=6.92; 95% CI -0.92, 14.75; p=0.08). In AIS subgroup, minocycline was associated with higher rates of 3-month mRS-scores of 0-2 (RR=1.59; 95% CI 1.19-2.12, p=0.002; I<sup>2</sup>=58%) and 3-month BI (MD=12.37; 95% CI 5.60, 19.14, p=0.0003; I<sup>2</sup>=47%), whereas reduced the 3-month NIHSS (MD -2.84; 95% CI -5.55, -0.13; p=0.04; I<sup>2</sup>=86%). Minocycline administration was not associated with an increased risk of mortality, recurrent stroke, myocardial infarction and hemorrhagic conversion.

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