Efficacy and safety of cilostazol in decreasing progression of cerebral white matter hyperintensities—A randomized controlled trial
Abstract Introduction Cerebral small vessel disease (SVD) is an important cause of dementia that lacks effective treatment. We evaluated the efficacy and safety of cilostazol, an antiplatelet agent with potential neurovascular protective effects, in slowing the progression of white matter hyperinten...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-01-01
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| Series: | Alzheimer’s & Dementia: Translational Research & Clinical Interventions |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/trc2.12369 |
| _version_ | 1797948986190987264 |
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| author | Bonaventure Y. M. Ip Bonnie Y. K. Lam Vincent M. H. Hui Lisa W. C. Au Mandy W. T. Liu Lin Shi Vivian W. Y. Lee Winnie C. W. Chu Thomas W. Leung Ho Ko Vincent C. T. Mok |
| author_facet | Bonaventure Y. M. Ip Bonnie Y. K. Lam Vincent M. H. Hui Lisa W. C. Au Mandy W. T. Liu Lin Shi Vivian W. Y. Lee Winnie C. W. Chu Thomas W. Leung Ho Ko Vincent C. T. Mok |
| author_sort | Bonaventure Y. M. Ip |
| collection | DOAJ |
| description | Abstract Introduction Cerebral small vessel disease (SVD) is an important cause of dementia that lacks effective treatment. We evaluated the efficacy and safety of cilostazol, an antiplatelet agent with potential neurovascular protective effects, in slowing the progression of white matter hyperintensities (WMHs) in stroke‐ and dementia‐free subjects harboring confluent WMH on magnetic resonance imaging (MRI). Methods In this single‐center, randomized, double‐blind, placebo‐controlled study, we randomized stroke‐ and dementia‐free subjects with confluent WMHs to receive cilostazol or placebo for 2 years in a 1:1 ratio. The primary outcome was change in WMH volume over 2 years. Secondary outcomes were changes in brain volumes, lacunes, cerebral microbleeds, perivascular space, and alterations in white matter microstructural integrity, cognition, motor function, and mood. Results We recruited 120 subjects from October 27, 2014, to January 21, 2019. A total of 55 subjects in the cilostazol group and 54 subjects in the control group were included for intention‐to‐treat analysis. At 2‐year follow‐up, the changes in WMH volume were not statistically different between cilostazol treatment and placebo (0.3±1.0 mL vs −0.1±0.8 mL, p = 0.167). Secondary outcomes, bleeding and vascular events, were also not statistically different between the two groups. Discussion In this trial with stroke‐ and dementia‐free subjects with confluent WMHs, cilostazol did not impact WMH progression but demonstrated an acceptable safety profile. Future studies should address the treatment effects of cilostazol on subjects at different clinical stages of SVD. |
| first_indexed | 2024-04-10T21:53:22Z |
| format | Article |
| id | doaj.art-6776c9f0269c4d9395276e1cef5d1921 |
| institution | Directory Open Access Journal |
| issn | 2352-8737 |
| language | English |
| last_indexed | 2024-04-10T21:53:22Z |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Alzheimer’s & Dementia: Translational Research & Clinical Interventions |
| spelling | doaj.art-6776c9f0269c4d9395276e1cef5d19212023-01-18T11:41:04ZengWileyAlzheimer’s & Dementia: Translational Research & Clinical Interventions2352-87372022-01-0181n/an/a10.1002/trc2.12369Efficacy and safety of cilostazol in decreasing progression of cerebral white matter hyperintensities—A randomized controlled trialBonaventure Y. M. Ip0Bonnie Y. K. Lam1Vincent M. H. Hui2Lisa W. C. Au3Mandy W. T. Liu4Lin Shi5Vivian W. Y. Lee6Winnie C. W. Chu7Thomas W. Leung8Ho Ko9Vincent C. T. Mok10Division of NeurologyDepartment of Medicine and TherapeuticsThe Chinese University of Hong Kong ShatinHong Kong SARChinaDivision of NeurologyDepartment of Medicine and TherapeuticsThe Chinese University of Hong Kong ShatinHong Kong SARChinaDivision of NeurologyDepartment of Medicine and TherapeuticsThe Chinese University of Hong Kong ShatinHong Kong SARChinaDivision of NeurologyDepartment of Medicine and TherapeuticsThe Chinese University of Hong Kong ShatinHong Kong SARChinaDivision of NeurologyDepartment of Medicine and TherapeuticsThe Chinese University of Hong Kong ShatinHong Kong SARChinaDepartment of Imaging and Interventional RadiologyThe Prince of Wale HospitalThe Chinese University of Hong Kong ShatinHong Kong SARChinaCentre for Learning Enhancement and ResearchThe Chinese University of Hong Kong Hong Kong SARChinaDepartment of Imaging and Interventional RadiologyThe Prince of Wale HospitalThe Chinese University of Hong Kong ShatinHong Kong SARChinaDivision of NeurologyDepartment of Medicine and TherapeuticsThe Chinese University of Hong Kong ShatinHong Kong SARChinaDivision of NeurologyDepartment of Medicine and TherapeuticsThe Chinese University of Hong Kong ShatinHong Kong SARChinaDivision of NeurologyDepartment of Medicine and TherapeuticsThe Chinese University of Hong Kong ShatinHong Kong SARChinaAbstract Introduction Cerebral small vessel disease (SVD) is an important cause of dementia that lacks effective treatment. We evaluated the efficacy and safety of cilostazol, an antiplatelet agent with potential neurovascular protective effects, in slowing the progression of white matter hyperintensities (WMHs) in stroke‐ and dementia‐free subjects harboring confluent WMH on magnetic resonance imaging (MRI). Methods In this single‐center, randomized, double‐blind, placebo‐controlled study, we randomized stroke‐ and dementia‐free subjects with confluent WMHs to receive cilostazol or placebo for 2 years in a 1:1 ratio. The primary outcome was change in WMH volume over 2 years. Secondary outcomes were changes in brain volumes, lacunes, cerebral microbleeds, perivascular space, and alterations in white matter microstructural integrity, cognition, motor function, and mood. Results We recruited 120 subjects from October 27, 2014, to January 21, 2019. A total of 55 subjects in the cilostazol group and 54 subjects in the control group were included for intention‐to‐treat analysis. At 2‐year follow‐up, the changes in WMH volume were not statistically different between cilostazol treatment and placebo (0.3±1.0 mL vs −0.1±0.8 mL, p = 0.167). Secondary outcomes, bleeding and vascular events, were also not statistically different between the two groups. Discussion In this trial with stroke‐ and dementia‐free subjects with confluent WMHs, cilostazol did not impact WMH progression but demonstrated an acceptable safety profile. Future studies should address the treatment effects of cilostazol on subjects at different clinical stages of SVD.https://doi.org/10.1002/trc2.12369braincerebral small vessel diseasescilostazolclinical trialsdementiaintention‐to‐treat analysis |
| spellingShingle | Bonaventure Y. M. Ip Bonnie Y. K. Lam Vincent M. H. Hui Lisa W. C. Au Mandy W. T. Liu Lin Shi Vivian W. Y. Lee Winnie C. W. Chu Thomas W. Leung Ho Ko Vincent C. T. Mok Efficacy and safety of cilostazol in decreasing progression of cerebral white matter hyperintensities—A randomized controlled trial Alzheimer’s & Dementia: Translational Research & Clinical Interventions brain cerebral small vessel diseases cilostazol clinical trials dementia intention‐to‐treat analysis |
| title | Efficacy and safety of cilostazol in decreasing progression of cerebral white matter hyperintensities—A randomized controlled trial |
| title_full | Efficacy and safety of cilostazol in decreasing progression of cerebral white matter hyperintensities—A randomized controlled trial |
| title_fullStr | Efficacy and safety of cilostazol in decreasing progression of cerebral white matter hyperintensities—A randomized controlled trial |
| title_full_unstemmed | Efficacy and safety of cilostazol in decreasing progression of cerebral white matter hyperintensities—A randomized controlled trial |
| title_short | Efficacy and safety of cilostazol in decreasing progression of cerebral white matter hyperintensities—A randomized controlled trial |
| title_sort | efficacy and safety of cilostazol in decreasing progression of cerebral white matter hyperintensities a randomized controlled trial |
| topic | brain cerebral small vessel diseases cilostazol clinical trials dementia intention‐to‐treat analysis |
| url | https://doi.org/10.1002/trc2.12369 |
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