Minocycline treatment in acute stroke - An open-label, evaluator-blinded study

Background: Ischemic animal model studies have shown a neuroprotective effect of minocycline. Objective: To analyze the effect of minocycline treatment in human acute ischemic stroke. Methods: We performed an open- label, evaluator- blinded study. Minocycline at a dosage of 200 mg was administered orally for 5 days. The therapeutic window of time was 6 to 24 hours after onset of stroke. Data from NIH Stroke Scale ( NIHSS), modified Rankin Scale ( mRS), and Barthel Index ( BI) were evaluated. The primary objective was to compare changes from baseline to day 90 in NIHSS in the minocycline group vs placebo. Results: One hundred fifty- two patients were included in the study. Seventy- four patients received minocycline treatment, and 77 received placebo. NIHSS and mRS were significantly lower and BI scores were significantly higher in minocycline- treated patients. This pattern was already apparent on day 7 and day 30 of follow- up. Deaths, myocardial infarctions, recurrent strokes, and hemorrhagic transformations during follow- up did not differ by treatment group. Conclusions: Patients with acute stroke had significantly better outcome with minocycline treatment compared with placebo. The findings suggest a potential benefit of minocycline in acute ischemic stroke.