on October 26, 2006
Published online before print October 26, 2006, doi: 10.1161/01.STR.0000249410.91473.44
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Submitted on May 31, 2006
From Acute Stroke Unit & Cerebrovascular Clinic (K.R.L.), University Department of Medicine & Therapeutics, Gardiner Institute, Western Infirmary, Glasgow, Scotland; Department of Neurosciences (A.D.), Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain; Department of Neurology (S.M.D.), Royal Melbourne Hospital, University of Melbourne, Parkville Vic, Melbourne, Australia; Department of Neurology (H.C.D.), University Duisburg-Essen, Essen, Germany; Department of Neurology (J.G.), University of Texas-Houston Medical School, Houston Tex; UCSD Stroke Center (P.L.), San Diego, Calif; Department of Neurology (A.S.), University of Alberta, Edmonton, Canada; AstraZeneca R&D Södertälje (T.A.), Medical Neuroscience, Södertälje, Sweden; AstraZeneca R&D Södertälje (H.G.H.), Medical Neuroscience, Södertälje, Sweden; AstraZeneca LP (U.E.), Wilmington De; Department of Neurosciences (J.A.Z.), University of California, San Diego, La Jolla, Calif. * To whom correspondence should be addressed. E-mail: k.r.lees{at}clinmed.gla.ac.uk.
Background and Purpose--NXY-059 is a free radical-trapping neuroprotectant demonstrated to reduce disability from ischemic stroke. We conducted analyses on additional end points and sensitivity analyses to confirm our findings. Methods--We randomized 1722 patients with acute ischemic stroke to a 72-hour infusion of placebo or intravenous NXY-059 within 6 hours of stroke onset. The primary outcome was disability at 90 days, as measured by the modified Rankin Scale (mRS), a 6-point scale ranging from 0 (no residual symptoms) to 5 (bed-bound, requiring constant care). Additional and exploratory analyses included mRS at 7 and 30 days; subgroup interactions with final mRS; assessments of activities of daily living by Barthel index; and National Institutes of Health Stroke Scale (NIHSS) neurological scores at 7 and 90 days. Results--NXY-059 significantly improved the distribution of the mRS disability score compared with placebo at 7, 30, and 90 days (Cochran-Mantel-Haenszel test P=0.002, 0.004, 0.038, respectively; 90-day common odds ratio 1.20; 95% CI, 1.01 to 1.42). The benefit was not attributable to any specific baseline characteristic, stratification variable or subgroup interaction. Neurological scores were improved at 7 days (odds ratio [OR], 1.46; 95% CI, 1.13, 1.89; P=0.003) and the Barthel index was improved at 7 and 30 days (OR, 1.55; 95% CI, 1.22, 1.98; P<0.0001; OR, 1.27; 95% CI, 1.01, 1.59; P=0.02). Conclusions--NXY-059 within 6 hours of acute ischemic stroke significantly reduced disability. Benefit on neurological scores and activities of daily living was detectable early but not significant at 90 days; however, our trial was underpowered to measure effects on the neurological examination. The benefit on disability is not confounded by interactions and is supported by other outcome measures.
Accepted on August 17, 2006
Additional Outcomes and Subgroup Analyses of NXY-059 for Acute Ischemic Stroke in the SAINT I Trial
Kennedy R. Lees MD, FRCP*;
Key words: acute care • drug trials • free radicals • ischemia • neuroprotection • NXY-059
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