Seby John, MD

Chen CLH, Venketasubramanian N, Lee CF, Wong KSL, and Bousser MG. Effects of MLC601 on Early Vascular Events in Patients After Stroke: The CHIMES Study. Stroke. 2013

Traditional Chinese medicine (TCM) is used extensively in Asia to help recovery after stroke. MLC601, marketed as NeuroAiD® is one such TCM which combines extracts from 9 plant and 5 animal components. The CHIMES study was recently published in Stroke. It was a placebo-controlled randomized trial of patients with acute, moderately-severe ischemic stroke (NIHSS 6-14) treated with NeuroAiD® within 72 hours for 3 months, in addition to standard treatment. NeuroAiD® was no better than placebo in improving outcomes (mRS).

Chen and colleagues did a post-hoc analysis of CHIMES looking at early vascular events. At 3 months, the composite endpoint consisting of nonfatal recurrent stroke, nonfatal acute coronary event or vascular death was significantly lesser in NeuroAiD® treated patients. Although not reaching statistical significance, the number of events within each endpoint subgroup was also lesser in the NeuroAiD® group. Mechanism of action is not understood, but does not seem to be related to antiplatelet, lipid or blood pressure modifying effects. Authors postulate that ATP-dependent potassium channel activation may provide myocardial and cerebral preconditioning and hence chronic cyto-protection.

Herbal remedies are used as first line treatments for all illnesses in an estimated 80% of the world’s population and some have good clinical evidence. In neurological disease for instance, butterbur extract now has Level A evidence for treating migraine. For believers in complimentary and alternative medicine, NeuroAiD® offers promising potential. If an add-on therapy safely reduces vascular events post stroke in addition to improving functional independence and motor recovery, that is a huge plus. The safety profile of NeuroAiD® appears acceptable so far. Further studies of course are needed to confirm effects.

We continue the search to improve on secondary stroke prevention. CHANCE was a recent “positive” secondary prevention trial in a Chinese population. Hope the future editions of CHIMES enjoy similar success.