The main purpose of the clinical trial is to evaluate the efficacy and safety of Mexidol® in sequential treatment for patients in the acute and early recovery periods of ischemic stroke compared to placebo. The effect of adding Mexidol® to standard therapy on the degree of impairment of vital functions was assessed including the degree of disability (according to the Modified Rankin Scale, mRS), the severity of neurological symptoms (according to the National Institutes of Health Stroke Scale, NIHSS) and the level of mobility of patients (according to the Rivermead Mobility Index).
As the main purpose of the clinical study is to evaluate safety and efficacy of a neuroprotector (Mexidol®), it was crucial to develop strict protocol requirements that would help to avoid the challenges of estimation of neuroprotective effect for stroke therapy. The current treatment options for stroke are still limited and do not take into account rehabilitation period and patients' further quality of life. As per protocol requirements, 313 participants were screened, 304 participants met all comprehensive eligibility criteria, 25 participants dropped out during the clinical trial period. The Modified Rankin Scale (mRS) was selected as the most representative primary outcome measuring tool due to the adequate representation of functional outcome. Additionally, the neuroprotective efficacy of Mexidol® was assessed for its ability to reduce stroke-related neurologic deficit, to improve mobility after stroke and to influence cognitive impairment and mood disorder symptoms.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
304
50 mg/ml IV solution, 250 mg tablets
Placebo IV solution, Placebo tablets
Almaty City Hospital № 7
Almaty, Kazakhstan
Kazan City Hospital № 7
Kazan', Russia
Change From Baseline in the Modified Rankin Scale (mRS) Scores at the End of the Course of Therapy
The Modified Rankin Scale (mRS) is used to measure the degree of disability in patients who have had a stroke. Possible scores range from 0 (no symptoms at all) to 5 (dead) \[6 point scale: min value 0, max value 5, higher scores mean a worse outcome\]. Change = (Visit 4, Day 71(+2) - Visit 0, Day 0-1 Scores).
Time frame: Baseline, Day 71
Percentage of Subjects Having Modified Rankin Scale (mRS) Scores >3 (Higher Degree of Disability) at the End of the Course of Therapy
The Modified Rankin Scale (mRS) is used to measure the degree of disability in patients who have had a stroke. Possible scores range from 0 (no symptoms at all) to 5 (dead) \[6 point scale: min value 0, max value 5, higher scores mean a worse outcome\].
Time frame: Day 71
Percentage of Subjects Having Modified Rankin Scale (mRS) Scores 0-1 (Normal or Lower Degree of Disability) at the End of the Course of Therapy
The Modified Rankin Scale (mRS) is used to measure the degree of disability in patients who have had a stroke. Possible scores range from 0 (no symptoms at all) to 5 (dead) \[6 point scale: min value 0, max value 5, higher scores mean a worse outcome\].
Time frame: Day 71
Change From Baseline in the National Institutes of Health Stroke Scale (NIHSS) Score at the End of the Course of Therapy
The National Institutes of Health Stroke Scale (NIHSS) is a systematic assessment tool that provides a quantitative measure of stroke-related neurologic deficit. The NIHSS is a 15-item neurologic examination stroke scale used to evaluate the effect of acute cerebral infarction on the levels of consciousness, language, neglect, visual-field loss, extraocular movement, motor strength, ataxia, dysarthria, and sensory loss. Ratings for each item are scored with 3 to 5 grades with 0 as normal, and there is an allowance for untestable items. The individual scores from each item are summed in order to calculate a patient's total NIHSS score. The maximum possible score is 42 (severe stroke), with the minimum score being a 0 (no stroke symptoms) \[43 point scale: min value 0, max value 42, higher scores mean a worse outcome\]. Change = (Visit 4, Day 71(+2) - Visit 0, Day 0-1 Scores).
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Kemerovo City Clinical Hospital № 11
Kemerovo, Russia
Research Institute - Regional Clinical Hospital № 1
Krasnodar, Russia
Federal Center for Brain and Neurotechnology
Moscow, Russia
Russian National Research Medical University n.a. N. I. Pirogov
Moscow, Russia
Rostov State Medical University
Rostov-on-Don, Russia
Alexandrovskaya Hospital
Saint Petersburg, Russia
St. Petersburg Clinical Hospital № 26
Saint Petersburg, Russia
City Hospital № 40 of Kurortny District
Saint Petersburg, Russia
...and 7 more locations
Time frame: Baseline, Day 71
Change From Baseline in the Rivermead Mobility Index (RMI) Score at the End of the Course of Therapy
The Rivermead Mobility Index (RMI) is a hierarchical mobility scale used in neurological rehabilitation. It includes 15 items related to bed mobility, transfers, walking, stair use, and running. The test is comprised of 14 questions, and the patient is then asked to stand for 10 seconds without any aid. Each response is scored yes or no with 1 point for each yes answer. The scores are summed with a range from 0 (poor mobility) to 15 (excellent mobility) \[16 point scale: min value 0, max value 15, higher scores mean a better outcome\]. Change = (Visit 4, Day 71(+2) - Visit 1, Day 1 Scores).
Time frame: Baseline, Day 71
Change From Baseline in the Montreal Cognitive Assessment (MoCA) Score at the End of the Course of Therapy
The Montreal Cognitive Assessment (MoCA) is a 30-point validated scale that covers multiple cognitive domains including spatiotemporal orientation, sustained attention, visuospatial function, executive function, verbal memory, language, naming, and abstract thinking \[31 point scale: min value 0, max value 30, higher scores mean a better outcome\]. Change = (Visit 4, Day 71(+2) - Visit 1, Day 1 Scores).
Time frame: Baseline, Day 71
Change From Baseline in the Hospital Anxiety and Depression Scale Score, Domain ANXIETY (HADS-A), at the End of the Course of Therapy
The Hospital Anxiety and Depression Scale (HADS) is a brief self-report measure that was specifically designed to screen for distinct dimensions of anxiety and depression in nonpsychiatric hospital departments; somatic symptoms were excluded \[22 point scale for each domain (Anxiety or Depression): min value 0, max value 21, higher scores mean a worse outcome\]. Change = (Visit 4, Day 71(+2) - Visit 1, Day 1 Scores).
Time frame: Baseline, Day 71
Change From Baseline in the Hospital Anxiety and Depression Scale Score, Domain DEPRESSION (HADS-D), at the End of the Course of Therapy
The Hospital Anxiety and Depression Scale (HADS) is a brief self-report measure that was specifically designed to screen for distinct dimensions of anxiety and depression in nonpsychiatric hospital departments; somatic symptoms were excluded \[22 point scale for each domain (Anxiety or Depression): min value 0, max value 21, higher scores mean a worse outcome\]. Change = (Visit 4, Day 71(+2) - Visit 1, Day 1 Scores).
Time frame: Baseline, Day 71