Adrenomedullin Safe in Ischemic Stroke, NfL and GFAP Levels Identified During Stroke, Fibrinogenase Improves Functional Outcomes

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Welcome to this special edition of Neurology News Network. I’m Marco Meglio. This week’s episode is centered around recent data from the 2024 International Stroke Conference.

Findings from an investigator-initiated AMFIS phase 2 trial showed that treatment with intravenous (IV) adrenomedullin (AM), a vasoactive peptide, was safe to use within the 24 hour window in patients with acute ischemic stroke (AIS). Although outcomes were not statistically significant vs placebo, investigators concluded that this therapy may contribute to improved AIS prognosis. All told, the primary end point of serious adverse events (AEs) related to treatment did not occur in all groups. Between the active group and those on placebo, the rates of favorable outcome (75.0% vs 68.9%; adjusted OR [aOR], 1.45; 95% CI, 0.32-6.53) and good outcome (90.0% vs 73.7%; aOR, 3.86; 95% CI, 0.67-22.11) on modified Rankin Scale were not statistically different. Furthermore, the rates of good outcome in the active group were comparable with those in the placebo group (85.0% vs 73.7%; aOR, 1.56; 95% CI, 0.72-3.39).

In a longitudinal biomarker analysis of a phase 2a trial (NCT04309474) assessing elezanumab, an agent specific to repulsive guidance molecule A (RGMa), findings showed increased levels of neurofilament light (NfL) and glial fibrillary acidic protein (GFAP) during acute stroke, which diminished over time with different temporal patterns. The preliminary analysis included 34 patients, aged 30-90 years old, with acute ischemic stroke, and 31 healthy adults. Participants were randomly assigned 1:1 to elezanumab or placebo by intravenous (IV) infusion within 24 hours of “last known normal” and every 4 weeks thereafter for 48 weeks for a total of 13 doses. Coming into the study, patients had a National Institute of Health Stroke Scale (NIHSS) total score of 7 to 21.

In a late-breaking presentation at the 2024 International Stroke Conference (ISC), held February 7-9, in Phoenix, Arizona, findings from a randomized, placebo-controlled study revealed that treatment with fibrinogenase injection within 72 hours after acute ischemic stroke (AIS) resulted in better functional outcomes to that of the control group. At 90 days post-randomization, results showed a significantly lower functional outcome on mRS scale for the fibrinogenase group than those on placebo (P <.001). In addition, functional outcomes were more favorable on day 90 (mRS score ≤2 86.73% vs 72.73%; OR, 2.11; 95% CI 1.10-4.03; P = .496). Between the 2 groups, the rate of bleeding and death events were not statistically significant (P = .627; P = .496).

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