Defining a Target Population to Effectively Test a Neuroprotective Drug.

Aged Aged, 80 and over Endovascular Procedures Female Humans Ischemic Stroke / drug therapy Male Middle Aged Models, Theoretical Neuroprotective Agents / therapeutic use Patient Selection Thrombectomy
infarction ischemia neuroprotection patient selection probability

Journal

Stroke
ISSN: 1524-4628
Titre abrégé: Stroke
Pays: United States
ID NLM: 0235266

Informations de publication

Date de publication:
01 2021
Historique:
pubmed: 12 1 2021
medline: 15 12 2021
entrez: 11 1 2021
Statut: ppublish

Résumé

We aim to identify the subgroup of acute ischemic stroke patients with higher probabilities of benefiting from a potential neuroprotective drug using baseline outcome predictors and test whether different selection criteria strategies can improve detected treatment effect. We analyzed the association between final infarct volume (FIV), measured on 24- to 72-hour computed tomography, and National Institutes of Health Stroke Scale at discharge/day 5 of acute stroke patients who underwent endovascular treatment. Models were adjusted for age, sex, and affected hemisphere. We analyzed the impact of absolute (5-15 mL) and relative (33%) FIV reductions in the National Institutes of Health Stroke Scale in the whole population and in different subsets of patients selected according to baseline imaging criteria using computed tomography perfusion. We analyzed 627 patients; association between FIV and 5-day National Institutes of Health Stroke Scale was best described with a quadratic function, with a regression coefficient β=1.56 ([95% CI, 1.45-1.67] Patients either with excellent outcomes after endovascular thrombectomy or with large infarcts may dilute the treatment effect in stroke neuroprotective drug trials. Computed tomography perfusion on admission may help selecting adequate patients according to expected drug effect profile.

Sections du résumé

BACKGROUND AND PURPOSE
We aim to identify the subgroup of acute ischemic stroke patients with higher probabilities of benefiting from a potential neuroprotective drug using baseline outcome predictors and test whether different selection criteria strategies can improve detected treatment effect.
METHODS
We analyzed the association between final infarct volume (FIV), measured on 24- to 72-hour computed tomography, and National Institutes of Health Stroke Scale at discharge/day 5 of acute stroke patients who underwent endovascular treatment. Models were adjusted for age, sex, and affected hemisphere. We analyzed the impact of absolute (5-15 mL) and relative (33%) FIV reductions in the National Institutes of Health Stroke Scale in the whole population and in different subsets of patients selected according to baseline imaging criteria using computed tomography perfusion.
RESULTS
We analyzed 627 patients; association between FIV and 5-day National Institutes of Health Stroke Scale was best described with a quadratic function, with a regression coefficient β=1.56 ([95% CI, 1.45-1.67]
CONCLUSIONS
Patients either with excellent outcomes after endovascular thrombectomy or with large infarcts may dilute the treatment effect in stroke neuroprotective drug trials. Computed tomography perfusion on admission may help selecting adequate patients according to expected drug effect profile.

Identifiants

DOI: 10.1161/STROKEAHA.120.032025 PMID: 33423513
pubmed: 33423513
doi: 10.1161/STROKEAHA.120.032025
doi:

Substances chimiques

Neuroprotective Agents 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

505-510

Auteurs

Marta Olivé-Gadea (M)

Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).
Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).

Manuel Requena (M)

Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).
Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).

Daniel Campos (D)

Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).
Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).

Alvaro Garcia-Tornel (A)

Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).
Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).

Matías Deck (M)

Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).
Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).

Marian Muchada (M)

Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).
Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).

Sandra Boned (S)

Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).
Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).

Noelia Rodríguez (N)

Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).
Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).

Jesús Juega (J)

Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).
Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).

David Rodríguez-Luna (D)

Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).
Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).

Jorge Pagola (J)

Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).
Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).

Marta Rubiera (M)

Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).
Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).

Macarena Hernández-Jiménez (M)

Apta Targets, Madrid, Spain (M.H.-J.).

Carlos A Molina (CA)

Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).
Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).

Marc Ribo (M)

Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).
Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Defining a Target Population to Effectively...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › Defining a Target Population to Effectively...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Procédures endovasculaires › Defining a Target Population to Effectively...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Defining a Target Population to Effectively...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Accident vasculaire cérébral › Accident vasculaire cérébral ischémique › Defining a Target Population to Effectively...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Defining a Target Population to Effectively...
questionsmedicales.fr › Techniques d'investigation › Modèles théoriques › Defining a Target Population to Effectively...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents du système nerveux central › Neuroprotecteurs › Defining a Target Population to Effectively...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Sélection de patients › Defining a Target Population to Effectively...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie cardiovasculaire › Procédures de chirurgie vasculaire › Thrombectomie › Defining a Target Population to Effectively...