Intravenous Minocycline in Acute Stroke

I put this in my list of 31 things I was going to demand after my next stroke.
Notice the discrepancy between results and conclusion.

http://stroke.ahajournals.org/content/44/9/2493.abstract.html?etoc

A Randomized, Controlled Pilot Study and Meta-analysis

1. Edith Kohler, MD, FRACP;
2. David A. Prentice, FRACP;
3. Timothy R. Bates, FRACP;
4. Graeme J. Hankey, MD, FRACP;
5. Anne Claxton, BSc;
6. Jolandi van Heerden, FRANZCR;
7. David Blacker, FRACP

+ Author Affiliations

1. From the Stroke Unit, Royal Perth Hospital, Perth, Australia (E.K., D.A.P., G.J.H., A.C.); Stroke Unit, Swan District Hospital, Perth, Australia (T.R.B.); and the Department of Radiology (J.v.H.) and Stroke Unit (D.B.), Sir Charles Gairdner Hospital, Perth, Australia.

1. Correspondence to Edith Kohler, MD, Stroke Unit, Royal Perth Hospital, Perth, Western Australia, Australia. E-mail Edith_Kohler@hotmail.com

Abstract

Background and Purpose—Minocycline, in animal models and 2 small randomized controlled human trials, is a promising neuroprotective agent in acute stroke. We analyzed the efficacy and safety of intravenous minocycline in acute ischemic and hemorrhagic stroke.

Methods—A multicenter prospective randomized open-label blinded end point evaluation pilot study of minocycline 100 mg administered intravenously, commenced within 24 hours of onset of stroke, and continued 12 hourly for a total of 5 doses, versus no minocycline. All participants received routine stroke care. Primary end point was survival free of handicap (modified Rankin Scale, ≤2) at day 90.

Results—Ninety-five participants were randomized; 47 to minocycline and 48 to no minocycline. In the intention-to-treat population, 29 of 47 (65.9%) allocated minocycline survived free of handicap compared with 33 of 48 (70.2%) allocated no minocycline (rate ratio, 0.94; 95% confidence interval, 0.71–1.25 and odds ratio, 0.73; 95% CI, 0.31–1.71). A meta-analysis of the 3 human trials suggests minocycline may increase the odds of handicap-free survival by 3-fold (odds ratio, 2.99; 95% CI, 1.74–5.16) but there was substantial heterogeneity among the trials.

Conclusions—In this pilot study of a small sample of acute stroke patients, intravenous minocycline was safe but not efficacious. The study was not powered to identify reliably or exclude a modest but clinically important treatment effect of minocycline. Larger trials would improve the precision of the estimates of any treatment effect of minocycline.

Clinical Trial Registration—URL: http://www.anzctr.org.au. Unique identifier: ACTRN12612000237886.