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Rheumatoid arthritis drug ‘reduces inflammation after stroke’

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An anti-inflammatory drug given to patients in the early stages of a stroke has been shown to reduce harmful inflammation, according to researchers in Greater Manchester.

The drug anakinra (Kineret), which is currently licenced for treating rheumatoid arthritis and marketed by Swedish Orphan Biovitrum, is one of biologic agents transforming treatment in a range of illnesses, according to researchers.

“We have shown that Kineret injections significantly reduces levels of inflammation in patients”

Craig Smith

Their study, funded by the Stroke Association, follows earlier research that shows the drug given as an intravenous therapy reduces inflammation in stroke and sub arachnoid haemorrhage patients.

In the new research, by the University of Manchester and Salford Royal NHS Foundation Trust, the drug was given as a small injection just under the skin without any identifiable adverse reactions.

Anakinra works by blocking the actions of the protein Interleukin-1 (IL-1), which is released into the body following injury caused by a stroke.

However, researchers at the University of Manchester have previously shown that IL-1 increases inflammation and brain injury following a stroke.

The current study, which was a double-blind trial where anakinra was tested against placebo at the trust’s stroke centre at the Salford Royal Hospital, looked at ischemic strokes only.

“The drug can be given quickly, via injection or via a drip. This means that it can be used in different settings”

Hilary Reynolds

The 80 participants in the study were given six doses of the drug or placebo over three days. The first dose was given within six hours after the onset of the stroke symptoms.

Inflammatory markers were measured in the blood before treatment began and during study treatment, indicating a reduction in inflammation.

Professor Craig Smith, from Manchester University and also a stroke physician at Salford Royal, said: “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 reduces levels of inflammation in patients,” he added.

The researchers, who have published their findings in the journal Stroke, could not determine for sure at this stage how the reduction in inflammation will impact on clinical outcomes.

“This could provide a major step forward in fast and effective treatment of stroke”

Hilary Reynolds

Hilary Reynolds, executive director of strategy and research at the Stroke Association, said: “This study builds on evidence that 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,” she said. “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,” said Ms Reynolds.

“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,” she added.

Further research is needed to see whether the drug is an effective treatment for ischemic stroke and whether it can be given alongside current treatments such as thrombolysis.

The same research team have shown that it reduces inflammation and is safe in patients with subarachnoid haemorrhage. To definitively test the drug improves outcomes in subarachnoid haemorrhage, a national trial involving 1,000 patients will start in 2018.

Another trial in 80 patients with intracerebral haemorrhage will also start in 2018. It will test if markers of inflammation are reduced by Kineret and test safety in intracerebral haemorrhage.

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