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(Stroke. 2006;37:2189.)
© 2006 American Heart Association, Inc.

Emerging Therapies

NXY-059

Brain or Vessel Protection

Marc Fisher, MD; Kennedy Lees, MD; Michalis Papadakis, PhD Alastair M. Buchan, MD, FRCPC

From the Acute Stroke Programme, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford, United Kingdom (M.P., A.M.B.); and the Henry Wellcome Building for Molecular Physiology, Oxford, United Kingdom (M.P.).

Correspondence to Prof Alastair M. Buchan, University of Oxford, Acute Stroke Programme, Nuffield Department of Medicine, Level 7, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom. E-mail alastair.buchan@ndm.ox.ac.uk

Key Words: neuroprotectants

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
NXY-059 is a nitrone compound with free radical trapping properties that appears to be neuroprotective in some animal models of stroke.^1,2 The publication this month of SAINT-I trial in the New England Journal of Medicine³ demonstrates a small but statistically significant improvement of the primary outcome by NXY-059 treatment. The authors observed reduced disability at 90 days as assessed by a shift in the modified Rankin scale. Patients were treated within 4 hours from stroke onset with doses of NXY-059 compatible with the neuroprotective effects seen in some animal models.^1,2

The development of the drug is to be commended in that a number of the STAIR criteria⁴ were followed, but there are questions that are being discussed. Critically, the site of action of NXY-059 has still not been conclusively determined, and this dispute originates from the poor permeability of NXY-059 across the blood–brain barrier.^2,5 Therefore, the question is if NXY-059 eventually exhibits any pharmacological protection by scavenging free radicals in the brain tissue. Alternatively, its mechanism of action might be a manifestation of physiological protection, mediated probably by improving cerebral blood flow.

Another consideration is whether the benefit of NXY-059 at 90 days, after stroke onset, is not a long-term effect, but rather a postponement of the injury. This is supported by the reduction of the odds for improved outcome by NXY-059 compared with placebo, from 7 to 30 to 90 days. Another criticism of the SAINT-I trial is that the modified Rankin scale is used in a nonconventional way, . . . [Full Text of this Article]

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