Researchers find that rheumatoid arthritis drug reduces harmful inflammation in early ischaemic stroke

Researchers from the University of Manchester and Salford Royal NHS Foundation Trust have found that an anti-inflammatory drug, used to treat rheumatoid arthritis (RA), reduces harmful inflammation when administered to patients in the early stages of stroke.

The pro-inflammatory cytokine interleukin-1 (IL-1), which is produced by the body as a defence mechanism to combat a range of illnesses, is known to have a deleterious role in ischaemic cerebral events. In previous research, scientists at the University of Manchester have shown that IL-1 increases inflammation and brain injury following a stroke. Kineret, a licensed drug for the treatment of RA, works by blocking the actions of IL-1.

In this double-blind, randomised placebo-controlled trial (published in Stroke), Kineret was administered to 80 patients at Salford’s Greater Manchester Stroke Centre at Salford Royal. Each participant was given a small injection of either the drug or placebo just under the skin, six times over the course of three days. The first dose was given within six hours of stroke symptoms starting. Inflammatory markers were measured in the blood before treatment began and during study treatment.

“Though strokes affect different people in different ways, for many people they have a devastating effect on their long-term health and wellbeing,” explained Professor Craig Smith from The University of Manchester who is also a stroke physician at Salford Royal. “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.”

The 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.

“This study builds on evidence that IL-1Ra (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. 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 2 million brain cells every minute during a stroke, so this could provide a major step forward in fast and effective treatment of stroke,” said Hilary Reynolds, executive director of Strategy & Research at the Stroke Association. “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.”

Further research is needed to see whether Kineret is an effective treatment for ischemic stroke and whether it can be given alongside current treatments such as clot-busting drugs (thrombolysis).

To definitively test if Kineret improves patient outcomes in subarachnoid haemorrhage, a national trial of Kineret in 1000 patients, funded by the Medical Research Council and National Institute for Health Research, will start in 2018.

And another trial in 80 patients with stroke caused bleeding in the brain, known as intracerebral haemorrhage, will also start in 2018. It is funded by the National Institute for Health Research.

That trial will test if markers of inflammation are reduced by Kineret and test safety in intracerebral haemorrhage.