Phase II Clinical Trial of Direkord: Randomized, Double-Blind, Placebo-Controlled, Parallel Group, and Prospective Studies to Select Optimal Dosage and to Study the Efficacy, Safety, and Tolerability in Ischemic Stroke Patients in the Early Recovery Period

Abstract

Direkord is an original drug containing the active substance of dicholine succinate, which improves the sensitivity of insulin receptors in neurons to insulin. The aim of the work was to select an optimal dosage and to study the efficacy, safety, and tolerability of Direkord, a solution for intramuscular injection, in ischemic stroke patients in the early recovery period. In total, 132 patients after the first ischemic stroke in the carotid system, confirmed by computed or magnetic resonance imaging, with the stroke remoteness from 3 weeks to 2 months and the mean age of 64.35±8.03 years, were randomized into three treatment groups. Patients in the first (n=44) and second (n=44) groups received Direkord intramuscularly for two weeks at a dose of 400 mg/day and 600 mg/day, respectively. Patients in the third group received placebo. The treatment response was assessed in terms of improved neurological status, functional state, and cognitive functions, including at least a two-fold decrease in the total score on the NIHSS scale, the total score on the Barthel scale ≥95, and the total score on the MoCA scale ≥26. Four weeks after the onset of the study, 34.1, 43.2, and 18.2% of the patients responded to therapy in the first, second, and third group, respectively. An analysis based on the Fisher’s exact test revealed a statistically significant difference between the groups (p=0.036). These results suggest that Direkord is statistically and clinically significantly superior to placebo at a two-week intramuscular therapy at a dose of 600 mg/day in patients with ischemic carotid stroke in the early recovery period. The safety profile of Direkord when used in various therapy regimens does not differ from that of placebo. The phase III study should confirm the preliminary results obtained in the current work.