Skip to main content
Top
Published in: Clinical Drug Investigation 10/2013

01-10-2013 | Original Research Article

Efficacy and Safety of Mildronate for Acute Ischemic Stroke: A Randomized, Double-Blind, Active-Controlled Phase II Multicenter Trial

Authors: Yi Zhu, Guangyun Zhang, Jun Zhao, Deshuai Li, Xiaodong Yan, Juanfang Liu, Xuedong Liu, Haibo Zhao, Jielai Xia, Xiao Zhang, Zhengyi Li, Baorong Zhang, Zongcheng Guo, Lianyuan Feng, Zhaodong Zhang, Fang Qu, Gang Zhao

Published in: Clinical Drug Investigation | Issue 10/2013

Login to get access

Abstract

Background and Objective

Mildronate, an inhibitor of carnitine-dependent metabolism, is considered to be an anti-ischemic drug. This study is designed to evaluate the efficacy and safety of mildronate injection in treating acute ischemic stroke.

Methods

We performed a randomized, double-blind, multicenter clinical study of mildronate injection for treating acute cerebral infarction. 113 patients in the experimental group received mildronate injection, and 114 patients in the active-control group received cinepazide injection. In addition, both groups were given aspirin as a basic treatment. Modified Rankin Scale (mRS) score was performed at 2 weeks and 3 months after treatment. National Institutes of Health Stroke Scale (NIHSS) score and Barthel Index (BI) score were performed at 2 weeks after treatment, and then vital signs and adverse events were evaluated.

Results

A total of 227 patients were randomized to treatment (n = 113, mildronate; n = 114, active-control). After 3 months, there was no significant difference for the primary endpoint between groups categorized in terms of mRS scores of 0–1 and 0–2 (p = 0.52 and p = 0.07, respectively). There were also no significant differences for the secondary endpoint between groups categorized in terms of NIHSS scores of >5 and >8 (p = 0.98 and p = 0.97, respectively) or BI scores of >75 and >95 (p = 0.49 and p = 0.47, respectively) at 15 days. The incidence of serious adverse events was similar between the two groups.

Conclusion

Mildronate injection is as effective and safe as cinepazide injection in treating acute cerebral infarction.
Literature
1.
go back to reference Naylor AR. Letter by Naylor regarding article, “Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association”. Stroke. 2011;42(6):e385; author reply e386. Naylor AR. Letter by Naylor regarding article, “Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association”. Stroke. 2011;42(6):e385; author reply e386.
2.
go back to reference Wood H. Stroke: could the neuroprotective drug NA-1 limit ischaemic brain damage after stroke? Nat Rev Neurol. 2012;8(12):658.PubMedCrossRef Wood H. Stroke: could the neuroprotective drug NA-1 limit ischaemic brain damage after stroke? Nat Rev Neurol. 2012;8(12):658.PubMedCrossRef
3.
go back to reference Blanco M, Castillo J. Stroke in 2012: major advances in the treatment of stroke. Nat Rev Neurol. 2013;9(2):68–70.PubMedCrossRef Blanco M, Castillo J. Stroke in 2012: major advances in the treatment of stroke. Nat Rev Neurol. 2013;9(2):68–70.PubMedCrossRef
4.
go back to reference Kingwell K. Stroke: neuroprotection for patients with stroke moves one step closer to the clinic. Nat Rev Neurol. 2012;8(4):178.PubMed Kingwell K. Stroke: neuroprotection for patients with stroke moves one step closer to the clinic. Nat Rev Neurol. 2012;8(4):178.PubMed
5.
go back to reference Cook DJ, Teves L, Tymianski M. Treatment of stroke with a PSD-95 inhibitor in the gyrencephalic primate brain. Nature. 2012;483(7388):213–7.PubMedCrossRef Cook DJ, Teves L, Tymianski M. Treatment of stroke with a PSD-95 inhibitor in the gyrencephalic primate brain. Nature. 2012;483(7388):213–7.PubMedCrossRef
6.
go back to reference Bach A, Clausen BH, Moller M, et al. A high-affinity, dimeric inhibitor of PSD-95 bivalently interacts with PDZ1-2 and protects against ischemic brain damage. Proc Natl Acad Sci USA. 2012;109(9):3317–22.PubMedCrossRef Bach A, Clausen BH, Moller M, et al. A high-affinity, dimeric inhibitor of PSD-95 bivalently interacts with PDZ1-2 and protects against ischemic brain damage. Proc Natl Acad Sci USA. 2012;109(9):3317–22.PubMedCrossRef
7.
go back to reference Vilskersts R, Liepinsh E, Mateuszuk L, et al. Mildronate, a regulator of energy metabolism, reduces atherosclerosis in apoE/LDLR−/− mice. Pharmacology. 2009;83(5):287–93.PubMedCrossRef Vilskersts R, Liepinsh E, Mateuszuk L, et al. Mildronate, a regulator of energy metabolism, reduces atherosclerosis in apoE/LDLR−/− mice. Pharmacology. 2009;83(5):287–93.PubMedCrossRef
8.
go back to reference Okunevich IV, Ryzhenkov VE. Anti-atherosclerotic action of mildronate in experiment [in Russian]. Patol Fiziol Eksp Ter. 2002;2:24–7.PubMed Okunevich IV, Ryzhenkov VE. Anti-atherosclerotic action of mildronate in experiment [in Russian]. Patol Fiziol Eksp Ter. 2002;2:24–7.PubMed
9.
go back to reference Dambrova M, Liepinsh E, Kalvinsh I. Mildronate: cardioprotective action through carnitine-lowering effect. Trends Cardiovasc Med. 2002;12(6):275–9.PubMedCrossRef Dambrova M, Liepinsh E, Kalvinsh I. Mildronate: cardioprotective action through carnitine-lowering effect. Trends Cardiovasc Med. 2002;12(6):275–9.PubMedCrossRef
10.
go back to reference Liepinsh E, Vilskersts R, Loca D, et al. Mildronate, an inhibitor of carnitine biosynthesis, induces an increase in gamma-butyrobetaine contents and cardioprotection in isolated rat heart infarction. J Cardiovasc Pharmacol. 2006;48(6):314–9.PubMedCrossRef Liepinsh E, Vilskersts R, Loca D, et al. Mildronate, an inhibitor of carnitine biosynthesis, induces an increase in gamma-butyrobetaine contents and cardioprotection in isolated rat heart infarction. J Cardiovasc Pharmacol. 2006;48(6):314–9.PubMedCrossRef
11.
go back to reference Vilskersts R, Liepinsh E, Kuka J, et al. Myocardial infarct size-limiting and anti-arrhythmic effects of mildronate orotate in the rat heart. Cardiovasc Drugs Ther. 2009;23(4):281–8.PubMedCrossRef Vilskersts R, Liepinsh E, Kuka J, et al. Myocardial infarct size-limiting and anti-arrhythmic effects of mildronate orotate in the rat heart. Cardiovasc Drugs Ther. 2009;23(4):281–8.PubMedCrossRef
12.
go back to reference Statsenko ME, Poletaeva LV, Turkina SV, et al. Mildronate effects on oxidant stress in type 2 diabetic patients with diabetic peripheral (sensomotor) neuropathy [in Russian]. Ter Arkh. 2008;80(10):27–30.PubMed Statsenko ME, Poletaeva LV, Turkina SV, et al. Mildronate effects on oxidant stress in type 2 diabetic patients with diabetic peripheral (sensomotor) neuropathy [in Russian]. Ter Arkh. 2008;80(10):27–30.PubMed
13.
go back to reference Sokolovska J, Rumaks J, Karajeva N, et al. The influence of mildronate on peripheral neuropathy and some characteristics of glucose and lipid metabolism in rat streptozotocin-induced diabetes mellitus model [in Russian]. Biomed Khim. 2011;57(5):490–500.PubMed Sokolovska J, Rumaks J, Karajeva N, et al. The influence of mildronate on peripheral neuropathy and some characteristics of glucose and lipid metabolism in rat streptozotocin-induced diabetes mellitus model [in Russian]. Biomed Khim. 2011;57(5):490–500.PubMed
14.
go back to reference Vilskersts R, Kuka J, Svalbe B, et al. Administration of l-carnitine and mildronate improves endothelial function and decreases mortality in hypertensive Dahl rats. Pharmacol Rep. 2011;63(3):752–62.PubMed Vilskersts R, Kuka J, Svalbe B, et al. Administration of l-carnitine and mildronate improves endothelial function and decreases mortality in hypertensive Dahl rats. Pharmacol Rep. 2011;63(3):752–62.PubMed
15.
go back to reference Beketov AI, Mametova AN, Polevik IV, et al. Comparative characteristics of cerebrovascular protective effects of mildronate, riboxine, and their combination during modeling of cerebral hemodynamics disturbance [in Russian]. Eksp Klin Farmakol. 2000;63(6):18–21.PubMed Beketov AI, Mametova AN, Polevik IV, et al. Comparative characteristics of cerebrovascular protective effects of mildronate, riboxine, and their combination during modeling of cerebral hemodynamics disturbance [in Russian]. Eksp Klin Farmakol. 2000;63(6):18–21.PubMed
16.
go back to reference Dziak LA, Golik VA. Use of mildronate for the treatment of patients with circulatory encephalopathy against a background of stenosis of major arteries of the head [in Russian]. Lik Sprava. 2003;5–6:98–101.PubMed Dziak LA, Golik VA. Use of mildronate for the treatment of patients with circulatory encephalopathy against a background of stenosis of major arteries of the head [in Russian]. Lik Sprava. 2003;5–6:98–101.PubMed
17.
go back to reference Sjakste N, Baumane L, Boucher JL, et al. Effects of gamma-butyrobetaine and mildronate on nitric oxide production in lipopolysaccharide-treated rats. Basic Clin Pharmacol Toxicol. 2004;94(1):46–50.PubMedCrossRef Sjakste N, Baumane L, Boucher JL, et al. Effects of gamma-butyrobetaine and mildronate on nitric oxide production in lipopolysaccharide-treated rats. Basic Clin Pharmacol Toxicol. 2004;94(1):46–50.PubMedCrossRef
18.
go back to reference Sjakste N, Kleschyov AL, Boucher JL, et al. Endothelium- and nitric oxide-dependent vasorelaxing activities of gamma-butyrobetaine esters: possible link to the antiischemic activities of mildronate. Eur J Pharmacol. 2004;495(1):67–73.PubMedCrossRef Sjakste N, Kleschyov AL, Boucher JL, et al. Endothelium- and nitric oxide-dependent vasorelaxing activities of gamma-butyrobetaine esters: possible link to the antiischemic activities of mildronate. Eur J Pharmacol. 2004;495(1):67–73.PubMedCrossRef
19.
go back to reference Liepinsh E, Konrade I, Skapare E, et al. Mildronate treatment alters gamma-butyrobetaine and l-carnitine concentrations in healthy volunteers. J Pharm Pharmacol. 2011;63(9):1195–201.PubMedCrossRef Liepinsh E, Konrade I, Skapare E, et al. Mildronate treatment alters gamma-butyrobetaine and l-carnitine concentrations in healthy volunteers. J Pharm Pharmacol. 2011;63(9):1195–201.PubMedCrossRef
20.
go back to reference Svalbe B, Zvejniece L, Vavers E, et al. Mildronate treatment improves functional recovery following middle cerebral artery occlusion in rats. Behav Brain Res. 2011;222(1):26–32.PubMedCrossRef Svalbe B, Zvejniece L, Vavers E, et al. Mildronate treatment improves functional recovery following middle cerebral artery occlusion in rats. Behav Brain Res. 2011;222(1):26–32.PubMedCrossRef
21.
go back to reference Pupure J, Isajevs S, Skapare E, et al. Neuroprotective properties of mildronate, a mitochondria-targeted small molecule. Neurosci Lett. 2010;470(2):100–5.PubMedCrossRef Pupure J, Isajevs S, Skapare E, et al. Neuroprotective properties of mildronate, a mitochondria-targeted small molecule. Neurosci Lett. 2010;470(2):100–5.PubMedCrossRef
22.
go back to reference Isajevs S, Isajeva D, Beitnere U, et al. Mildronate as a regulator of protein expression in a rat model of Parkinson’s disease. Medicina (Kaunas). 2011;47(10):552–9. Isajevs S, Isajeva D, Beitnere U, et al. Mildronate as a regulator of protein expression in a rat model of Parkinson’s disease. Medicina (Kaunas). 2011;47(10):552–9.
23.
go back to reference Sjakste N, Gutcaits A, Kalvinsh I. Mildronate: an antiischemic drug for neurological indications. CNS Drug Rev. 2005;11(2):151–68.PubMedCrossRef Sjakste N, Gutcaits A, Kalvinsh I. Mildronate: an antiischemic drug for neurological indications. CNS Drug Rev. 2005;11(2):151–68.PubMedCrossRef
24.
go back to reference Fearon P, McArthur KS, Garrity K, et al. Prestroke modified Rankin Stroke Scale has moderate interobserver reliability and validity in an acute stroke setting. Stroke. 2012;43(12):3184–8.PubMedCrossRef Fearon P, McArthur KS, Garrity K, et al. Prestroke modified Rankin Stroke Scale has moderate interobserver reliability and validity in an acute stroke setting. Stroke. 2012;43(12):3184–8.PubMedCrossRef
25.
go back to reference Liu X, Xia J, Wang L, et al. Efficacy and safety of ginsenoside-Rd for acute ischaemic stroke: a randomized, double-blind, placebo-controlled, phase II multicenter trial. Eur J Neurol. 2009;16(5):569–75.PubMedCrossRef Liu X, Xia J, Wang L, et al. Efficacy and safety of ginsenoside-Rd for acute ischaemic stroke: a randomized, double-blind, placebo-controlled, phase II multicenter trial. Eur J Neurol. 2009;16(5):569–75.PubMedCrossRef
26.
go back to reference Liu X, Wang L, Wen A, et al. Ginsenoside-Rd improves outcome of acute ischaemic stroke - a randomized, double-blind, placebo-controlled, multicenter trial. Eur J Neurol. 2012;19(6):855–63.PubMedCrossRef Liu X, Wang L, Wen A, et al. Ginsenoside-Rd improves outcome of acute ischaemic stroke - a randomized, double-blind, placebo-controlled, multicenter trial. Eur J Neurol. 2012;19(6):855–63.PubMedCrossRef
27.
go back to reference Akashi A, Hirohashi M, Suzuki I, et al. Cardiovascular pharmacology of cinepazide, a new cerebral vasodilator (author’s transl) [in Japanese]. Nihon Yakurigaku Zasshi. 1979;75(5):507–16.PubMedCrossRef Akashi A, Hirohashi M, Suzuki I, et al. Cardiovascular pharmacology of cinepazide, a new cerebral vasodilator (author’s transl) [in Japanese]. Nihon Yakurigaku Zasshi. 1979;75(5):507–16.PubMedCrossRef
28.
go back to reference Baba M, Kitamura K. The effects of cinepazide on cerebral circulation (author’s transl) [in Japanese]. No To Shinkei. 1979;31(6):621–9.PubMed Baba M, Kitamura K. The effects of cinepazide on cerebral circulation (author’s transl) [in Japanese]. No To Shinkei. 1979;31(6):621–9.PubMed
29.
go back to reference Warembourg G, Carre A, Ginestet A, et al. Clinical experimentation with a new vasodilator: cinepazide maleate in arterial diseases of the lower limbs [in French]. Lille Med. 1976;21(Suppl 4):898–901.PubMed Warembourg G, Carre A, Ginestet A, et al. Clinical experimentation with a new vasodilator: cinepazide maleate in arterial diseases of the lower limbs [in French]. Lille Med. 1976;21(Suppl 4):898–901.PubMed
30.
go back to reference Moritake K, Handa H, Takebe Y, et al. Effect of intravenous administration of Cinepazide on cerebral blood flow and evoked potentials [in Japanese]. Nihon Geka Hokan. 1983;52(2):207–17.PubMed Moritake K, Handa H, Takebe Y, et al. Effect of intravenous administration of Cinepazide on cerebral blood flow and evoked potentials [in Japanese]. Nihon Geka Hokan. 1983;52(2):207–17.PubMed
31.
go back to reference Kitaoka H, Ohya K, Sano M. Interaction between cinepazide maleate, a new cerebral vasodilator, and water [in Japanese]. Yakugaku Zasshi. 1983;103(1):28–33.PubMed Kitaoka H, Ohya K, Sano M. Interaction between cinepazide maleate, a new cerebral vasodilator, and water [in Japanese]. Yakugaku Zasshi. 1983;103(1):28–33.PubMed
32.
go back to reference Fujishima M. Agents to improve cerebrovascular circulation and cerebral metabolism–cinepazide [in Japanese]. Nihon Rinsho. 1985;43(2):379-82. Fujishima M. Agents to improve cerebrovascular circulation and cerebral metabolism–cinepazide [in Japanese]. Nihon Rinsho. 1985;43(2):379-82.
33.
go back to reference Muramatsu I, Sakakibara Y, Hong SC, et al. Effects of cinepazide on the purinergic responses in the dog cerebral artery. Pharmacology. 1984;28(1):27–33.PubMedCrossRef Muramatsu I, Sakakibara Y, Hong SC, et al. Effects of cinepazide on the purinergic responses in the dog cerebral artery. Pharmacology. 1984;28(1):27–33.PubMedCrossRef
34.
go back to reference Sesti C, Simkhovich BZ, Kalvinsh I, et al. Mildronate, a novel fatty acid oxidation inhibitor and antianginal agent, reduces myocardial infarct size without affecting hemodynamics. J Cardiovasc Pharmacol. 2006;47(3):493–9.PubMed Sesti C, Simkhovich BZ, Kalvinsh I, et al. Mildronate, a novel fatty acid oxidation inhibitor and antianginal agent, reduces myocardial infarct size without affecting hemodynamics. J Cardiovasc Pharmacol. 2006;47(3):493–9.PubMed
35.
go back to reference Stanley WC. Partial fatty acid oxidation inhibitors for stable angina. Expert Opin Investig Drugs. 2002;11(5):615–29.PubMedCrossRef Stanley WC. Partial fatty acid oxidation inhibitors for stable angina. Expert Opin Investig Drugs. 2002;11(5):615–29.PubMedCrossRef
36.
go back to reference Dambrova M, Daiia D, Liepin’Sh E, et al. Biochemical mechanisms of mildronate action during ischemic stress [in Russian]. Lik Sprava. 2004;2:68–74.PubMed Dambrova M, Daiia D, Liepin’Sh E, et al. Biochemical mechanisms of mildronate action during ischemic stress [in Russian]. Lik Sprava. 2004;2:68–74.PubMed
37.
go back to reference Zvejniece L, Svalbe B, Makrecka M, et al. Mildronate exerts acute anticonvulsant and antihypnotic effects. Behav Pharmacol. 2010;21(5–6):548–55.PubMedCrossRef Zvejniece L, Svalbe B, Makrecka M, et al. Mildronate exerts acute anticonvulsant and antihypnotic effects. Behav Pharmacol. 2010;21(5–6):548–55.PubMedCrossRef
38.
go back to reference Liepinsh E, Vilskersts R, Skapare E, et al. Mildronate decreases carnitine availability and up-regulates glucose uptake and related gene expression in the mouse heart. Life Sci. 2008;83(17–18):613–9.PubMedCrossRef Liepinsh E, Vilskersts R, Skapare E, et al. Mildronate decreases carnitine availability and up-regulates glucose uptake and related gene expression in the mouse heart. Life Sci. 2008;83(17–18):613–9.PubMedCrossRef
39.
go back to reference Sjakste N, Gutcaits A, Kalvinsh I. Mildronate: an antiischemic drug for neurological indications. CNS Drug Rev. 2005;11(2):151–68.PubMedCrossRef Sjakste N, Gutcaits A, Kalvinsh I. Mildronate: an antiischemic drug for neurological indications. CNS Drug Rev. 2005;11(2):151–68.PubMedCrossRef
Metadata
Title
Efficacy and Safety of Mildronate for Acute Ischemic Stroke: A Randomized, Double-Blind, Active-Controlled Phase II Multicenter Trial
Authors
Yi Zhu
Guangyun Zhang
Jun Zhao
Deshuai Li
Xiaodong Yan
Juanfang Liu
Xuedong Liu
Haibo Zhao
Jielai Xia
Xiao Zhang
Zhengyi Li
Baorong Zhang
Zongcheng Guo
Lianyuan Feng
Zhaodong Zhang
Fang Qu
Gang Zhao
Publication date
01-10-2013
Publisher
Springer International Publishing
Published in
Clinical Drug Investigation / Issue 10/2013
Print ISSN: 1173-2563
Electronic ISSN: 1179-1918
DOI
https://doi.org/10.1007/s40261-013-0121-x

Other articles of this Issue 10/2013

Clinical Drug Investigation 10/2013 Go to the issue