Researchers at the University of Manchester and Salford Royal NHS Foundation Trust, UK, have shown that an anti-inflammatory drug, which has been given to patients in the early stages of stroke, can reduce harmful inflammation.
The drug, Kineret©, is licensed for treating rheumatoid arthritis and given as a small injection just under the skin without giving the patients any identifiable adverse reactions. It’s one of many biologic agents transforming treatment in a range of illnesses, with stroke being the next target.
The protein Interelukin-1 (IL-1) is part of the body’s defences and naturally produced to combat an array of illnesses.
However, scientists at Manchester University have shown previously that IL-1 can cause harm, increasing inflammation and brain injury following a cerebrovascular accident (CVA).
How does Kineret work?
Kineret blocks the actions of IL-1, which is released into the body following injury caused by a CVA. Researchers can’t say for sure at this stage how the reduction in inflammation will impact on clinical outcomes.
The study follows earlier research which shows that giving the drug as intravenous therapy reduces inflammation in stroke and subarachnoid haemorrhage patients.
The two main types of CVA are:
• Ischaemic – caused by lack of blood flow; and
• Haemorrhagic – caused by bleeding in the brain.
What happened in the study?
The Kineret drug was tested against a placebo and looked at ischaemic strokes only. 80 participants were given six doses of the drug or placebo over a three-day period. The first dose was given within six hours after the onset of stroke symptoms.
Inflammatory markers were measured in the blood before treatment began and during study treatment.
Professor Craig Smith from the University of Manchester, who is also stroke physician at Salford Royal, said: “Though strokes affect different people in different ways, for many people they have a devastating effect on their long-term health and wellbeing.
“Excessive inflammation after a stroke is known to be harmful and predicts a worse outcome in patients.
“We have shown that Kineret injections, started within six hours of stroke onset, significantly reduce levels of inflammation in patients.”
The future of stroke treatment
Hilary Reynolds, executive director of strategy & research at the Stroke Association, said: “This study builds on evidence that IL-1Ra (Kineret) helps to reduce inflammation and brain damage in a wide range of stroke patients soon after a stroke. The drug can be given quickly, via injection or via a drip.
“This means that it can be used in different settings; for example, it could potentially be given in ambulances on the way to hospital. The brain loses around two million brain cells every minute during a stroke, so this could provide a major step forward in fast and effective treatment of stroke.”
She concluded: “The research has not yet proven that this drug can reduce patient disability after stroke. However, if further trials are successful, we hope it could vastly improve outcomes and quality of life for people who have had a stroke.”
Further research is needed
To definitively test if Kineret improves patient outcomes in subarachnoid haemorrhage, a national trial of Kineret in 1,000 patients will start in 2018.
Another trial in 80 patients with stroke-caused bleeding in the brain, known as intracerebral haemorrhage, will also start in 2018.