Efficacy and safety of nerinetide for the treatment of acute ischaemic stroke (ESCAPE-NA1): a multicentre, double-blind, randomised controlled trial

In patients with disabling ischaemic stroke (n=1105), IV nerinetide (2.6mg/kg; max 270mg) did not improve the proportion of patients achieving a favourable functional outcome (modified Rankin Scale score of 0–2) after endovascular thrombectomy (61.4% v 59.2% placebo; p=0.35).

SPS commentary:

Although there was no statistically significant difference between nerinetide and placebo for the primary outcome, the authors note an observed benefit for patients who received nerinetide and were not treated with usual-care alteplase (exploratory analysis; RR 1.19; 1.01-1.41). A related commentary notes that although this result might be a chance finding or confounded by the indication for alteplase, it could possibly be due to a drug-drug interaction between alteplase and nerinetide; this hypothesis is supported by pharmacokinetic data in a small number of patients treated with nerinetide, which showed that alteplase lowered plasma concentrations of nerinetide.


The Lancet

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