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Published in: Trials 1/2017

Open Access 01-12-2017 | Study protocol

Xingnaojing for Moderate-to-severe Acute ischemic Stroke (XMAS): study protocol for a randomized controlled trial

Authors: Xinxing Lai, Kegang Cao, Lingbo Kong, Qiang Liu, Ying Gao, for the XMAS study investigators

Published in: Trials | Issue 1/2017

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Abstract

Background

Xingnaojing injection (XNJ) is widely used for the treatment of stroke in China. However, there is currently a lack of high-quality evidence of its efficacy for acute ischemic stroke. The main objective of this study is to determine whether the addition of XNJ to standard care improves the 3-month functional outcome in patients with acute ischemic stroke (AIS).

Methods/design

The XMAS study is a multicenter, prospective, randomized controlled, open-label trial with a blinded endpoints design. A total of 720 patients will be randomly allocated to either the intervention or the control group in a 1:1 ratio. The intervention group receives XNJ combined with standard care, and the control group receives standard care alone. XNJ will be administered intravenously every 12 h for 10 days. The primary outcome is the proportion of patients who are independent at 3 months after stroke onset defined as a modified Rankin Scale score of 0 to 2. Secondary outcomes include early neurological deterioration at 48 h, the change in National Institutes of Health Stroke Scale score, patient-reported outcome, symptomatic intracranial hemorrhage at 10 days, the Barthel Index score, deaths from any cause and cardiovascular events at 3 months.

Discussion

The results of this trial will provide critical evidence for XNJ in the treatment of AIS as a complementary approach that can be initiated after reperfusion therapy or when the AIS is not eligible for thrombolytic treatment.

Trial registration

Clinical Trials.gov, ID: NCT02728180. Registered on 28 March 2016.
Appendix
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Literature
1.
go back to reference GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385(9963):117–71.CrossRef GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385(9963):117–71.CrossRef
2.
go back to reference Krishnamurthi RV, Feigin VL, Forouzanfar MH, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet Glob Health. 2013;1(5):e259–81.CrossRefPubMedPubMedCentral Krishnamurthi RV, Feigin VL, Forouzanfar MH, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet Glob Health. 2013;1(5):e259–81.CrossRefPubMedPubMedCentral
3.
go back to reference Wang W, Jiang B, Sun H, Ru X, Sun D, Wang L, et al. Prevalence, incidence and mortality of stroke in China: results from a nationwide population-based survey of 480,687 adults. Circulation. 2017;135(8):759-71. Wang W, Jiang B, Sun H, Ru X, Sun D, Wang L, et al. Prevalence, incidence and mortality of stroke in China: results from a nationwide population-based survey of 480,687 adults. Circulation. 2017;135(8):759-71.
4.
go back to reference Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, et al. 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46(10):3020–35.CrossRefPubMed Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, et al. 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46(10):3020–35.CrossRefPubMed
5.
6.
go back to reference Wu B, Liu M, Liu H, Li W, Tan S, Zhang S, Fang Y. Meta-analysis of traditional Chinese patent medicine for ischemic stroke. Stroke. 2007;38(6):1973–9.CrossRefPubMed Wu B, Liu M, Liu H, Li W, Tan S, Zhang S, Fang Y. Meta-analysis of traditional Chinese patent medicine for ischemic stroke. Stroke. 2007;38(6):1973–9.CrossRefPubMed
7.
go back to reference Yu L, Wang N, Zhang Y, Wang Y, Li J, Wu Q, Liu Y. Neuroprotective effect of muscone on glutamate-induced apoptosis in PC12 cells via antioxidant and Ca2+ antagonism. Neurochem Int. 2014;70:10–21.CrossRefPubMed Yu L, Wang N, Zhang Y, Wang Y, Li J, Wu Q, Liu Y. Neuroprotective effect of muscone on glutamate-induced apoptosis in PC12 cells via antioxidant and Ca2+ antagonism. Neurochem Int. 2014;70:10–21.CrossRefPubMed
8.
go back to reference Wei G, Huang Y, Li F, Zeng F, Li Y, Deng R, et al. XingNaoJing, prescription of traditional Chinese medicine, prevents autophagy in experimental stroke by repressing p53-DRAM pathway. BMC Complement Altern Med. 2015;15:377.CrossRefPubMedPubMedCentral Wei G, Huang Y, Li F, Zeng F, Li Y, Deng R, et al. XingNaoJing, prescription of traditional Chinese medicine, prevents autophagy in experimental stroke by repressing p53-DRAM pathway. BMC Complement Altern Med. 2015;15:377.CrossRefPubMedPubMedCentral
9.
go back to reference Wei J, Yao L, Yang L, Zhao W, Shi S, Cai Q, et al. Alteration of glutamate/GABA balance during acute alcohol intoxication in rats: effect of Xingnaojing injection. J Ethnopharmacol. 2015;166:333–9.CrossRefPubMed Wei J, Yao L, Yang L, Zhao W, Shi S, Cai Q, et al. Alteration of glutamate/GABA balance during acute alcohol intoxication in rats: effect of Xingnaojing injection. J Ethnopharmacol. 2015;166:333–9.CrossRefPubMed
10.
go back to reference Xia X, Li Q, Liu M. Neuroprotective effect of a formula, Moschus combined with Borneolum Synthcticum, from Traditional Chinese Medicine on ischemia stroke in rats. Evid Based Complement Alternat Med. 2014;2014:1–10. Xia X, Li Q, Liu M. Neuroprotective effect of a formula, Moschus combined with Borneolum Synthcticum, from Traditional Chinese Medicine on ischemia stroke in rats. Evid Based Complement Alternat Med. 2014;2014:1–10.
11.
go back to reference Peng W, Yang J, Wang Y, Wang W, Xu J, Wang L, Xing Z. Systematic review and meta-analysis of randomized controlled trials of Xingnaojing treatment for stroke. Evid Based Complement Alternat Med. 2014;2014:210851.PubMedPubMedCentral Peng W, Yang J, Wang Y, Wang W, Xu J, Wang L, Xing Z. Systematic review and meta-analysis of randomized controlled trials of Xingnaojing treatment for stroke. Evid Based Complement Alternat Med. 2014;2014:210851.PubMedPubMedCentral
12.
go back to reference van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19(5):604–7.CrossRefPubMed van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19(5):604–7.CrossRefPubMed
13.
go back to reference Brott T, Adams HJ, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20(7):864–70.CrossRefPubMed Brott T, Adams HJ, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20(7):864–70.CrossRefPubMed
14.
go back to reference Wang X, Liu Q, Zhong H, Gao Y. Second run clinical verification of patient-reported outcome scale of stroke. Chin J Tradit Chin Med Pharm. 2012;27(05):1245–8 [Article in Chinese]. Wang X, Liu Q, Zhong H, Gao Y. Second run clinical verification of patient-reported outcome scale of stroke. Chin J Tradit Chin Med Pharm. 2012;27(05):1245–8 [Article in Chinese].
15.
go back to reference Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J. 1965;14:61–5.PubMed Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J. 1965;14:61–5.PubMed
16.
go back to reference Sandercock P, Wardlaw JM, Lindley RI, Dennis M, Cohen G, Murray G, et al. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet. 2012;379(9834):2352–63.CrossRefPubMed Sandercock P, Wardlaw JM, Lindley RI, Dennis M, Cohen G, Murray G, et al. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet. 2012;379(9834):2352–63.CrossRefPubMed
17.
go back to reference Gu C, Fu Y, Wang Y, Wu J. Xinnaojing injection in the treatment of acute ischemic stroke: a clinical trial of 85 patients. J Emerg Tradit Chin Med. 2009;18(12):1989–90 [Article in Chinese]. Gu C, Fu Y, Wang Y, Wu J. Xinnaojing injection in the treatment of acute ischemic stroke: a clinical trial of 85 patients. J Emerg Tradit Chin Med. 2009;18(12):1989–90 [Article in Chinese].
18.
go back to reference Lian Q, Dong H, 03. Clinical observation of Xinnaojing injection in the treatment of acute ischemic stroke. J Emerg Tradit Chin Med. 2010;19:430–1 [Article in Chinese]. Lian Q, Dong H, 03. Clinical observation of Xinnaojing injection in the treatment of acute ischemic stroke. J Emerg Tradit Chin Med. 2010;19:430–1 [Article in Chinese].
19.
go back to reference Li M. Clinical efficacy of Xingnaojing injection in the treatment of acute ischemic stroke. Strait Pharm J. 2011;3(07):153–5 [Article in Chinese]. Li M. Clinical efficacy of Xingnaojing injection in the treatment of acute ischemic stroke. Strait Pharm J. 2011;3(07):153–5 [Article in Chinese].
20.
go back to reference Su S, Lu A, Li S, Jia W. Evidence-based ZHENG: a traditional Chinese medicine syndrome 2013. Evid Based Complement Alternat Med. 2014;2014:1–2. Su S, Lu A, Li S, Jia W. Evidence-based ZHENG: a traditional Chinese medicine syndrome 2013. Evid Based Complement Alternat Med. 2014;2014:1–2.
21.
go back to reference Little RJ, D’Agostino R, Cohen ML, Dickersin K, Emerson SS, Farrar JT, et al. The prevention and treatment of missing data in clinical trials. N Engl J Med. 2012;367(14):1355–60.CrossRefPubMedPubMedCentral Little RJ, D’Agostino R, Cohen ML, Dickersin K, Emerson SS, Farrar JT, et al. The prevention and treatment of missing data in clinical trials. N Engl J Med. 2012;367(14):1355–60.CrossRefPubMedPubMedCentral
22.
go back to reference Smith DH, Neutel JM, Lacourciere Y, Kempthorne-Rawson J. Prospective, randomized, open-label, blinded-endpoint (PROBE) designed trials yield the same results as double-blind, placebo-controlled trials with respect to ABPM measurements. J Hypertens. 2003;21(7):1291–8.CrossRefPubMed Smith DH, Neutel JM, Lacourciere Y, Kempthorne-Rawson J. Prospective, randomized, open-label, blinded-endpoint (PROBE) designed trials yield the same results as double-blind, placebo-controlled trials with respect to ABPM measurements. J Hypertens. 2003;21(7):1291–8.CrossRefPubMed
23.
go back to reference O’Neil WM, Welner SA, Lip GY. Do open label blinded outcome studies of novel anticoagulants versus warfarin have equivalent validity to those carried out under double-blind conditions? Thromb Haemost. 2013;109(3):497–503.CrossRefPubMed O’Neil WM, Welner SA, Lip GY. Do open label blinded outcome studies of novel anticoagulants versus warfarin have equivalent validity to those carried out under double-blind conditions? Thromb Haemost. 2013;109(3):497–503.CrossRefPubMed
24.
go back to reference Westendorp WF, Vermeij J, Zock E, Hooijenga IJ, Kruyt ND, Bosboom HJLW, et al. The Preventive Antibiotics in Stroke Study (PASS): a pragmatic randomised open-label masked endpoint clinical trial. Lancet. 2015;385(9977):1519–26.CrossRefPubMed Westendorp WF, Vermeij J, Zock E, Hooijenga IJ, Kruyt ND, Bosboom HJLW, et al. The Preventive Antibiotics in Stroke Study (PASS): a pragmatic randomised open-label masked endpoint clinical trial. Lancet. 2015;385(9977):1519–26.CrossRefPubMed
Metadata
Title
Xingnaojing for Moderate-to-severe Acute ischemic Stroke (XMAS): study protocol for a randomized controlled trial
Authors
Xinxing Lai
Kegang Cao
Lingbo Kong
Qiang Liu
Ying Gao
for the XMAS study investigators
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Trials / Issue 1/2017
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-017-2222-y

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