To Study efficacy and safety of citicoline in acute ischemic stroke
Keywords:
CDP-choline, Ischemic penumbra, NeuroprotectionAbstract
Background: Stroke is a medical emergency with mortality rate higher than most forms of cancer. Acute ischemic stroke is a complex entity with variable clinical manifestations depending on the site and extent of infarction. Besides standard treatment given to the patients, neuroprotection is being targeted to antagonize molecular events that lead to irreversible ischemic injury.
Methods: In this study, role of Citicoline in acute ischemic stroke was studied. It was open label study of 12 weeks duration undertaken in Medicine department (emergency unit) of Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Amritsar. Total 40 patients were randomly divided into Group 1 and Group 2. Group 1 received standard treatment for acute ischemic stroke and Group 2 received citicoline in addition to standard treatment. Patients were assessed at admission and after every 24 hours till hospital discharge. Follow up of the patients was done at three weeks, six weeks and twelve weeks after discharge using National Institute of Health Stroke Scale (NIHSS), Modified Rankin Scale (MRS) and Modified Barthel Index (MBI). The data was statistically analysed using Mann Whitney test.
Results: No significant difference was found between two groups with respect to MRS and MBI score throughout the study period. Statistically significant improvement was seen in citicoline group on NIHSS score by 2nd and 3rd day of admission and then on 12th week.
Conclusions: Citicoline was found to be safe but with no statistically significant difference in treatment outcome between two groups.
References
Goldstein M, Barnett HJM, Orgogozo JM, Sartorius N, Symon L, Vereshchagin NV. Recommendations on stroke prevention, diagnosis and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke 1989;20(10): 1407-31.
Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. A prospective study of acute cerebrovascular disease in the community: the Oxfordshire Community Stroke Project--1981-86. 2. Incidence, case fatality rates and overall outcome at one year of cerebral infarction, primary intracerebral and subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 1990 Jan;53(1):16-22.
Baldwin K, Orr S, Briand M, Piazza C, Veydt A, McCoy S. Acute Ischemic Stroke Update. Pharmacotherapy 2010 May;30(5):493-514.
Aminoff MJ. Nervous system disorders. In: McPhee SJ, Papadakis MA, Tierney LM. Current Medical Diagnosis and Treatment. 47ed. New York: McGraw Hill; 2008:837-96.
Adibhatla RM, Hatcher JF. Citicoline mechanisms and clinical efficacy in cerebral ischemia. J Neurosci Res 2002 Oct 15;70(2):133-9.
WM Clark. Efficacy of citicoline as an acute stroke treatment. Expert Opin Pharmacother. 2009 Apr;10(5):839-46.
Brott T, Adams HP, Olinger CP, Marler JR, Barsan WG, Biller J et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989;20:864-70.
Wilson JL, Hareendran A, Grant M. Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the modified Rankin Scale. Stroke 2002;33:2243-6.
Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol 1989;42(8):703-9.
Clark WM, Williams BJ, Selzer KA, Zweifler RM, Sabounjian LA, Gammans RE. A randomized efficacy trial of citicoline in patients with acute ischemic stroke. Stroke 1999;30:2592-7.
Clark WM, Wechsler LR, Sabounjian LA, Schwiderski UE. A Phase III randomized efficacy trial of 2000 mg citicoline in acute ischemic stroke patients. Neurology 2001;57(9):1595-602.
Cho HJ, Kim YJ. Efficacy and safety of oral citicoline in acute ischemic stroke: drug surveillance study in 4,191 cases. Methods Find Exp Clin Pharmacol 2009 Apr;31(3):171-6.
