Evidence-based Evaluation of TCM Key Syndrome Differentiation and Treatment for Acute Ischemic Stroke

Phase 4

• Conditions: Ischemic Stroke
• Interventions: Drug: Placebo; Drug: Integrative Treatment (EPACH Recipe Granules + NQABC Recipe Granules)

• Registration Number: NCT04199455
• Lead Sponsor: Guangzhou University of Traditional Chinese Medicine

Brief Summary

The main purpose of this trial is to determine whether Chinese medicine (CM) for eliminating phlegm and clearing heat (EPACH) recipe continuously with nourishing Qi and activating blood circulation (NQABC) recipe, oral within 72 hours of symptom onset, improves the 15-day neurologicl deficits in participants with acute ischemic stroke.

Detailed Description

Many years of clinical practice experience has found that Chinese medicine (CM) for EPACH recipe continuously with NQABC recipe can be beneficial to the recovery of neurological function in the early stage of ischemic stroke. However, there is lack of high-quality evidence of its efficacy for acute ischemic stroke currently. The primary hypothesis of this trial is that Chinese herbal therapeutic regimen of EPACH+NQABC combined with guideline-based standard treatment will improve the 15-day neurological deficits in patients with acute ischemic stroke (AIS). Totally 500 participants will be randomized to the integrative treatment group treated with EPACH + NQABC recipes granules in addition to guideline-based standard treatment or the control group with placebo and guideline-based standard treatment equally for 15 days. All patients will have a National Institutes of Health Stroke Scale (NIHSS) entry score of 4-25. Patients in each group will be treated according to guideline-based standard treatment, but patients who have received or intend to undergo intravenous thrombolysis or endovascular interventions (including intravascular mechanical thrombectomy, arterial thrombolysis, angioplasty) are excluded. The primary outcome will be determined at 15 days, and all the participants will be followed up for 90 days.

Study Timeline

• Status Verified: 2019-12
• Study Start: 2019-12-04
• Study First Submitted: 2019-12-08
• Study First Submitted QC: 2019-12-12
• Last Update Submitted: 2019-12-12
• Study First Posted: 2019-12-16
• Last Update Posted: 2019-12-16
• Primary Completion: 2021-05-30
• Study Completion: 2021-08-30

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 500

Inclusion Criteria

• Acute disabling ischemic stroke (4≤ NIHSS score ≤25 at the time of randomization) that can be treated with study drug within 72 hours of symptoms onset. Acute ischemic stroke, were confirmed by magnetic resonance imaging (MRI) or computer tomography (CT).
• Adult subjects (male or female ≥ 40 years and ≤ 80 years)
• Diagnosis of phlegm-dampness syndrome with manifestation of heat (the score of "Phlegm-dampness syndrome" ≥10 with the score of "Internal fire syndrome" ≥2 in Diagnostic Scale for Syndrome Elements of Ischemic Stroke.
• Patient or legally authorized representative has signed informed consent.

Exclusion Criteria

• Planned or already receiving intravenous thrombolysis or endovascular treatment (intravascular mechanical thrombectomy, intra-arterial thrombolysis and angioplasty).
• Patients who have received other traditional Chinese Medicine Decoctions (Granules) and Chinese patent medicines Treatment for stroke.
• Confirmed secondary stroke caused by tumors, brain trauma, hematological diseases, infectious diseases, hereditary diseases, rheumatic immune diseases, etc
• modified Rankin Scale (mRS) Score > 2 at randomization (pre-morbid historical assessment).
• Other conditions that lead to motor dysfunction (i.n., severe osteoarthritis, rheumatoid arthritis, gouty arthritis, etc).
• Significant renal or hepatic insufficiency (defined as a serum creatinine concentration, alanine aminotransferase (ALT), or aspartate aminotransferase (AST) value that is twice the upper limit of normal)
• Severe non-cardiovascular comorbidity with life expectancy < 3 months.
• Complicated with other diseases that limited the evaluation of neurological function or affect the follow-up of patients.
• Known to be pregnant or breastfeeding.
• Currently receiving an investigational drug.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Control Group	Placebo	Patients randomly assigned to the control group will receive recipe simulators as placebo, which will be manufactured by the Beijing Kangrentang Pharmaceutical company, combined with standard stroke care according to the Guidelines for the diagnosis and treatment of acute ischemic stroke in China 2018.
Integrative Treatment Group	Integrative Treatment (EPACH Recipe Granules + NQABC Recipe Granules)	Patients randomly assigned to the intervention group will receive EPACH and NQABC Chinese herbal compound granules, which will be manufactured by the Beijing Kangrentang Pharmaceutical company, combined with standard stroke care according to the Guidelines for the diagnosis and treatment of acute ischemic stroke in China 2018.

Primary Outcome Measures

Name	Time	Method
Comparison of the change in the NIHSS scores from baseline to 15 days in the two groups.	Baseline and 15 days.	The NIHSS score ranges from 0 (best score) to 42 (worst score).

Secondary Outcome Measures

Name	Time	Method
Proportion of Patients Independent	30 days and 90 days after symptom onset.	Proportion of patients independent is defined as Modified Rankin Scale score of 0, 1, or 2.
Activities of Daily Living	30 days and 90 days after symptom onset.	The Barthel Index score ranges from 0 (worst score) to 100 (best score).
Proportion of complications during hospitalization	During the period of hospitalization, an average of 10 to 15 days	The complications include hemorrhagic transformation, pulmonary infection, urinary tract infection, Gastrointestinal hemorrhage, etc.
Patient Reported Outcome (PRO) Scale of Stroke	15 days after randomization	PRO score ranges from 36 (best score) to 180 (worst score). PRO consists of four dimensions including the influence on physical, emotional, and social functioning, as well as the overall satisfaction with treatment.
Stoke Syndrome Factor Evaluation Scale	5 days and 15 days after randomization.	The Stroke Syndrome Factor Evaluation Scale ( a preliminary scale) is formed based on item response theory． It contains 76 items，among which there are 8 items of endogenous wind syndrome，24 items of endogenous fire syndrome, 12 items of phlegm-dampness syndrome, 8 items of blood stasis syndrome, 15 items of Qi deficiency syndrome, and 9 items of Yin deficiency syndrome．

Trial Locations

Locations (1)

Guangdong Provincial Hospital of Chinese medicine; 🇨🇳 Guangzhou, Guangdong, China