Post-Stroke Cognitive Impairment (PSCI)
Conditions
Keywords
Post-Stroke Cognitive Impairment (PSCI), Stroke, Actovegin, Cognition disorders
Brief summary
The aim of this trial is to provide evidence that Actovegin has a symptomatic effect in subjects with post stroke cognitive impairment (PSCI) during a six month treatment period compared to subjects administered placebo. Subjects received IV infusions whilst in hospital, and tablets once discharged. Subjects were followed up for a further six months after their treatment had been stopped to explore if the cognitive symptoms of the subjects treated with Actovegin showed sustained improvement. The trial also explored the possible prevention of dementia with Actovegin in patients who had suffered a recent ischaemic stroke, as well as the effect of Actovegin on other stroke outcomes. Safety information on Actovegin was collected.
Detailed description
The drug tested in this study is called actovegin. Actovegin was tested to treat people who have post stroke cognitive impairment. This study looked at the improvement of cognitive symptoms in people who take actovegin compared to placebo. The study enrolled 503 patients. Participants were randomly assigned (by chance, like flipping a coin) to one of the two treatment groups-which remained undisclosed to the patient and study doctor during the study: * Actovegin-2000 mg intravenous solution; 2- 200 mg tablets 3 times a day * Placebo intravenous solution; tablets (dummy inactive) - this is a solution or tablet that looks like the study drug but has no active ingredient All participants received daily intravenous infusions in the hospital (up to a maximum of 20 infusions) followed by 2-200 mg tablets three times a day for the remainder of the 6-month treatment period. This multi-centre trial was conducted in Belarus, Kazakhstan and Russia. The overall time to participate in this study was 12 months. Participants made multiple visits to the clinic plus a final visit after receiving their last dose of study drug for a follow-up assessment.
Interventions
Actovegin solution for infusion and Actovegin tablets
Actovegin placebo-matching solution for infusion and Actovegin placebo-matching tablets
Sponsors
Study design
Eligibility
Inclusion criteria
Main Inclusion Criteria: * Participant has suffered a recent supra-tentorial ischaemic stroke supported by computed tomography (CT) scan or magnetic resonance imaging (MRI) findings (in accordance with local practice). * Participant is male or female, aged 60 years or above. * Participant has a score on the National Institute of Health Stroke Scale (NIHSS) between 3 and 18 (inclusive). * Participant is capable of completing the Montreal Cognitive Assessment (MoCA) and has a score of ≤ 25 points with adjustment for level of education (4-9 school years ≤ 23 points, 10-12 years ≤ 24 points, \>12 years ≤ 25 points). Main
Exclusion criteria
* Participant has a medical history of dementia. * Participant has a known medical history of major depression or psychotic disorder. * Participant is indicated for treatment with thrombolytics or carotid surgery as the current standard of care. Randomisation Criteria: * Inclusion Criteria. * Ability to perform Alzheimer's Disease Assessment Scale + Cognitive Subscale Extended Version (ADAS-cog+). *
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Alzheimer's Disease Assessment Scale + Cognitive Subscale Extended Version (ADAS-cog+) at Month 6 | Baseline and Month 6 | The ADAS-cog measures cognitive performance by combining the ratings of 11 items. The cognitive domains mainly addressed by ADAS-cog are: memory (short term), language, ability to orientate (reflects memory), construction/planning of simple designs and performance. The extended version of the ADAS-cog (ADAS-cog+) includes 3 additional items: a 2-number cancellation task to test for attention, a delayed recall task to test for memory consolidation and a maze test for executive performance. Each item is scored and then the item scores are totaled. Total scores range from 0 (best) to 90 (worst). Higher scores indicate greater cognitive impairment. A negative change from Baseline indicates improvement. Analysis of Covariance (ANCOVA) model was used for analyses that included treatment, pooled centre, and their interaction as factors and Baseline ADAS-cog+ score as a covariate. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Montreal Cognitive Assessment Scale (MoCA) at End of Infusion Period, Months 3, 6 and 12 | Baseline, End of Infusion and Months 3, 6 and 12 | The MoCA is a rapid screening test to assess mild cognitive impairment. It assesses different cognitive domains: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation. Time to administer the MoCA is approximately 10 minutes. The total possible score is 0 to 30 points; a score of 26 or above is considered normal. A positive change from Baseline (BL) indicates improvement. ANCOVA model was used for analyses that included treatment and pooled centres as factors, plus years of education and baseline MoCA score as covariates. |
| Percentage of ADAS-cog+ Responders at Time Points 3, 6 and 12 Months | Baseline and Months 3, 6 and 12 | Responder was defined as an improvement of 4 or more from baseline on the ADAS-cog+ scale using observed data. The proportion of responders was compared between treatments using a chi-square test. |
| Percentage of Participants With a Diagnosis of Dementia | Month 6 | Diagnosis of dementia will be evaluated after 6 and 12 months classified according to International Statistical Classification of Diseases and related Health Problems 10th Revision (ICD-10) \[Classification of Mental and Behavioural Disorders, Diagnostic Criteria for Research\]. The proportion of participants with dementia was compared between treatments using a Fisher's exact test. |
| Change From Baseline in National Institutes of Health Stroke Scale (NIHSS) at End of Infusion Period, Months 3, 6 and 12 | Baseline and End of Infusion and Months 3, 6 and 12 | The NIHSS is a tool to objectively quantify the impairment caused by a stroke. The NIHSS is composed of 11 items, each of which scores a specific ability between a 0 (normal) to 4 (some level of impairment). The individual scores from each item are summed in order to calculate total possible NIHSS score from 0 (best) to 42 (worst). A negative change from Baseline indicates improvement. ANCOVA model was used for analyses that included treatment and pooled centre as factors and Baseline NIHSS score as a covariate. |
| Change From Baseline in ADAS-cog+ at Month 3 and Month 12 | Baseline and Months 3 and 12 | The ADAS-cog measures cognitive performance by combining the ratings of 11 items. The cognitive domains mainly addressed by ADAS-cog are: memory (short term), language, ability to orientate (reflects memory), construction/planning of simple designs and performance. The extended version of the ADAS-cog (ADAS-cog+) includes 3 additional items: a 2-number cancellation task to test for attention, a delayed recall task to test for memory consolidation and a maze test for executive performance. Each item is scored and then the item scores are totaled. Total scores range from 0 (best) to 90 (worst). Higher scores indicate greater cognitive impairment. A negative change from Baseline indicates improvement. ANCOVA model was used for analyses that included treatment, pooled centre, and their interaction as factors and Baseline ADAS-cog+ score as a covariate. |
| EuroQol EQ-5D (EQ-5D) at Month 6 | Month 6 | EQ-5D is a standardized measure of health status consisting of 5 dimensions: mobility, self -care, usual activities, pain/discomfort and anxiety/depression. The participant rates their level of function in each area using a 5 point scale where 1=no problems (best) to 5=extreme problems (worst). The percentage of participants in each category is reported. |
| EuroQol EQ-5D (EQ-5D) at Month 12 | Month 12 | EQ-5D is a standardized measure of health status consisting of 5 dimensions: mobility, self -care, usual activities, pain/discomfort and anxiety/depression. The participant rates their level of function in each area using a 5 point scale where 1=no problems (best) to 5=extreme problems (worst). The percentage of participants in each category is reported. |
| EuroQol EQ-5D (EQ-5D) General Health at Months 6 and 12 | Months 6 and 12 | The EuroQoL included a visual analogue scale where the subject marks how they feel at that moment on a scale from 0 (the worst health that can be imagined) to 100 (the best health that can be imagined). |
| Beck Depression Inventory, Version II (BDI-II) at Months 3, 6 and 12 | Months 3, 6 and 12 | The BDI-II is a 21-question multiple-choice self-report inventory for measuring the severity of depression. is composed of items relating to symptoms of depression such as hopelessness and irritability, cognitions such as guilt or feelings of being punished, as well as physical symptoms such as fatigue, weight loss, and lack of interest in sex. Each answer is scored on a scale 0 (best) to 3 (worst). Total scores range from 0 to 63 with higher scores indicating more severe depression. BDI II scale: * 0-13 minimal depression * 14-19 mild depression * 20-28 moderate depression * 29-63 severe depression |
| Barthel Index at Months 3 and 6 | Months 3 and 6 | The Barthel Index consists of 10 items that measure a person's daily functioning, specifically the activities of daily living and mobility. The items include: feeding, transfers (bed to chair and back), grooming, toilet use, bathing, mobility (walking on level surface), going up and down stairs, dressing, continence of bowels and bladder. Each performance item is rated, with a given number of points assigned to each level or ranking. Individual scores are summed for a total possible scores ranging from 0 (worst) to 100 (best) with higher scores indicating more independent daily living. |
Countries
Belarus, Kazakhstan, Russia
Participant flow
Recruitment details
Participants took part in the study at 33 investigative sites in Belarus, Kazakhstan and Russia from 28 June 2012 to 26 November 2014.
Pre-assignment details
Participants who had suffered ischaemic stroke were enrolled equally in 1 of 2 treatment groups, actovegin 2000 mg solution (up to 20 infusions) followed by 200 mg tablets 3 times a day or placebo.
Participants by arm
| Arm | Count |
|---|---|
| Actovegin Actovegin 2000 mg solution, intravenous (IV) infusion for up to 20 days followed by 2 actovegin 200 mg, tablets, orally, 3 times a day for up to 6 months. | 248 |
| Placebo Actovegin placebo-matching solution, intravenous (IV) infusion for up to 20 days followed by 2 actovegin placebo-matching, tablets, orally, 3 times a day for up to 6 months. | 255 |
| Total | 503 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 2 | 3 |
| Overall Study | Carotid or Neurosurgery | 0 | 1 |
| Overall Study | Death | 8 | 5 |
| Overall Study | Disallowed Concomitant Medication | 3 | 2 |
| Overall Study | General Anaesthesia | 0 | 1 |
| Overall Study | Lost to Follow-up | 1 | 2 |
| Overall Study | Other Miscellaneous Reason | 1 | 0 |
| Overall Study | Physician Decision | 0 | 1 |
| Overall Study | Recurrent Stroke | 13 | 8 |
| Overall Study | Withdrawal by Participant | 8 | 11 |
Baseline characteristics
| Characteristic | Actovegin | Placebo | Total |
|---|---|---|---|
| Age, Continuous | 70.3 years STANDARD_DEVIATION 6.65 | 69.6 years STANDARD_DEVIATION 7.18 | 69.9 years STANDARD_DEVIATION 6.92 |
| Age, Customized ≤ 65 years | 78 participants | 97 participants | 175 participants |
| Age, Customized > 65 years | 170 participants | 158 participants | 328 participants |
| Alcohol Consumption Daily drinker | 0 participants | 1 participants | 1 participants |
| Alcohol Consumption Never drank | 117 participants | 126 participants | 243 participants |
| Alcohol Consumption Occasional drinker | 131 participants | 128 participants | 259 participants |
| Diabetes No | 208 participants | 198 participants | 406 participants |
| Diabetes Yes | 40 participants | 57 participants | 97 participants |
| Fertility Status of Female Participants Post-menopausal | 117 participants | 137 participants | 254 participants |
| Fertility Status of Female Participants Surgically Sterile/Hysterectomized | 3 participants | 5 participants | 8 participants |
| Height | 167.6 cm STANDARD_DEVIATION 7.47 | 167.2 cm STANDARD_DEVIATION 7.89 | 167.4 cm STANDARD_DEVIATION 7.68 |
| Ischaemic Heart Disease or Peripheral Artery Disease No | 3 participants | 2 participants | 5 participants |
| Ischaemic Heart Disease or Peripheral Artery Disease Yes | 245 participants | 253 participants | 498 participants |
| Number of Years of Education | 12.2 years STANDARD_DEVIATION 3.41 | 12.3 years STANDARD_DEVIATION 3.4 | 12.3 years STANDARD_DEVIATION 3.4 |
| Previous Ischaemic Stroke No | 208 participants | 217 participants | 425 participants |
| Previous Ischaemic Stroke Yes | 40 participants | 38 participants | 78 participants |
| Race/Ethnicity, Customized Asian | 3 participants | 3 participants | 6 participants |
| Race/Ethnicity, Customized Black or African American | 1 participants | 1 participants | 2 participants |
| Race/Ethnicity, Customized Other | 4 participants | 3 participants | 7 participants |
| Race/Ethnicity, Customized White | 240 participants | 248 participants | 488 participants |
| Region of Enrollment Belarus | 56 participants | 58 participants | 114 participants |
| Region of Enrollment Kazakhstan | 2 participants | 2 participants | 4 participants |
| Region of Enrollment Russia | 190 participants | 195 participants | 385 participants |
| Sex: Female, Male Female | 120 Participants | 142 Participants | 262 Participants |
| Sex: Female, Male Male | 128 Participants | 113 Participants | 241 Participants |
| Smoking Status Current smoker | 53 participants | 37 participants | 90 participants |
| Smoking Status Ex-smoker | 23 participants | 23 participants | 46 participants |
| Smoking Status Never smoked | 172 participants | 195 participants | 367 participants |
| Weight | 78.3 kg STANDARD_DEVIATION 13.76 | 78.0 kg STANDARD_DEVIATION 13.73 | 78.1 kg STANDARD_DEVIATION 13.73 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 31 / 250 | 31 / 253 |
| serious Total, serious adverse events | 22 / 250 | 17 / 253 |
Outcome results
Change From Baseline in Alzheimer's Disease Assessment Scale + Cognitive Subscale Extended Version (ADAS-cog+) at Month 6
The ADAS-cog measures cognitive performance by combining the ratings of 11 items. The cognitive domains mainly addressed by ADAS-cog are: memory (short term), language, ability to orientate (reflects memory), construction/planning of simple designs and performance. The extended version of the ADAS-cog (ADAS-cog+) includes 3 additional items: a 2-number cancellation task to test for attention, a delayed recall task to test for memory consolidation and a maze test for executive performance. Each item is scored and then the item scores are totaled. Total scores range from 0 (best) to 90 (worst). Higher scores indicate greater cognitive impairment. A negative change from Baseline indicates improvement. Analysis of Covariance (ANCOVA) model was used for analyses that included treatment, pooled centre, and their interaction as factors and Baseline ADAS-cog+ score as a covariate.
Time frame: Baseline and Month 6
Population: Intent-to-treat population, all enrolled participants who received at least one dose of study drug, with data available for analysis. Missing individual item scores (where only some item scores missing) imputed with worst possible score and missing total scores (where all item scores missing) imputed by last observation carried forward.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Actovegin | Change From Baseline in Alzheimer's Disease Assessment Scale + Cognitive Subscale Extended Version (ADAS-cog+) at Month 6 | -6.8 score on a scale | Standard Error 0.58 |
| Placebo | Change From Baseline in Alzheimer's Disease Assessment Scale + Cognitive Subscale Extended Version (ADAS-cog+) at Month 6 | -4.6 score on a scale | Standard Error 0.58 |
Barthel Index at Months 3 and 6
The Barthel Index consists of 10 items that measure a person's daily functioning, specifically the activities of daily living and mobility. The items include: feeding, transfers (bed to chair and back), grooming, toilet use, bathing, mobility (walking on level surface), going up and down stairs, dressing, continence of bowels and bladder. Each performance item is rated, with a given number of points assigned to each level or ranking. Individual scores are summed for a total possible scores ranging from 0 (worst) to 100 (best) with higher scores indicating more independent daily living.
Time frame: Months 3 and 6
Population: Participants from the Intent-to-treat population, all enrolled participants who received at least one dose of study drug, with data available for analyses at the given time-point.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Actovegin | Barthel Index at Months 3 and 6 | Month 3 (n=224,235) | 100.0 score on a scale |
| Actovegin | Barthel Index at Months 3 and 6 | Month 6 (n=219,228) | 100.0 score on a scale |
| Placebo | Barthel Index at Months 3 and 6 | Month 3 (n=224,235) | 100.0 score on a scale |
| Placebo | Barthel Index at Months 3 and 6 | Month 6 (n=219,228) | 100.0 score on a scale |
Beck Depression Inventory, Version II (BDI-II) at Months 3, 6 and 12
The BDI-II is a 21-question multiple-choice self-report inventory for measuring the severity of depression. is composed of items relating to symptoms of depression such as hopelessness and irritability, cognitions such as guilt or feelings of being punished, as well as physical symptoms such as fatigue, weight loss, and lack of interest in sex. Each answer is scored on a scale 0 (best) to 3 (worst). Total scores range from 0 to 63 with higher scores indicating more severe depression. BDI II scale: * 0-13 minimal depression * 14-19 mild depression * 20-28 moderate depression * 29-63 severe depression
Time frame: Months 3, 6 and 12
Population: Participants from the Intent-to-treat population, all enrolled participants who received at least one dose of study drug, with data available for analyses at the given time-point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Actovegin | Beck Depression Inventory, Version II (BDI-II) at Months 3, 6 and 12 | Month 3 (n=224, 234) | 12.5 score on a scale | Standard Deviation 11.02 |
| Actovegin | Beck Depression Inventory, Version II (BDI-II) at Months 3, 6 and 12 | Month 6 (n=219, 227) | 11.3 score on a scale | Standard Deviation 8.88 |
| Actovegin | Beck Depression Inventory, Version II (BDI-II) at Months 3, 6 and 12 | Month 12 (n=212, 220) | 10.7 score on a scale | Standard Deviation 7.1 |
| Placebo | Beck Depression Inventory, Version II (BDI-II) at Months 3, 6 and 12 | Month 3 (n=224, 234) | 11.6 score on a scale | Standard Deviation 8.08 |
| Placebo | Beck Depression Inventory, Version II (BDI-II) at Months 3, 6 and 12 | Month 6 (n=219, 227) | 11.5 score on a scale | Standard Deviation 10.58 |
| Placebo | Beck Depression Inventory, Version II (BDI-II) at Months 3, 6 and 12 | Month 12 (n=212, 220) | 11.5 score on a scale | Standard Deviation 8.24 |
Change From Baseline in ADAS-cog+ at Month 3 and Month 12
The ADAS-cog measures cognitive performance by combining the ratings of 11 items. The cognitive domains mainly addressed by ADAS-cog are: memory (short term), language, ability to orientate (reflects memory), construction/planning of simple designs and performance. The extended version of the ADAS-cog (ADAS-cog+) includes 3 additional items: a 2-number cancellation task to test for attention, a delayed recall task to test for memory consolidation and a maze test for executive performance. Each item is scored and then the item scores are totaled. Total scores range from 0 (best) to 90 (worst). Higher scores indicate greater cognitive impairment. A negative change from Baseline indicates improvement. ANCOVA model was used for analyses that included treatment, pooled centre, and their interaction as factors and Baseline ADAS-cog+ score as a covariate.
Time frame: Baseline and Months 3 and 12
Population: Intent-to-treat population, all enrolled participants who received at least one dose of study drug, with data available for analysis. Missing individual item scores (where only some item scores missing) imputed with worst possible score.
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| Actovegin | Change From Baseline in ADAS-cog+ at Month 3 and Month 12 | Change from Baseline at Month 3 (n=224, 234) | -5.4 score on a scale | Standard Error 0.53 |
| Actovegin | Change From Baseline in ADAS-cog+ at Month 3 and Month 12 | Change from Baseline at Month 12 (n=211, 219) | -8.2 score on a scale | Standard Error 0.66 |
| Placebo | Change From Baseline in ADAS-cog+ at Month 3 and Month 12 | Change from Baseline at Month 3 (n=224, 234) | -4.3 score on a scale | Standard Error 0.52 |
| Placebo | Change From Baseline in ADAS-cog+ at Month 3 and Month 12 | Change from Baseline at Month 12 (n=211, 219) | -4.5 score on a scale | Standard Error 0.66 |
Change From Baseline in Montreal Cognitive Assessment Scale (MoCA) at End of Infusion Period, Months 3, 6 and 12
The MoCA is a rapid screening test to assess mild cognitive impairment. It assesses different cognitive domains: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation. Time to administer the MoCA is approximately 10 minutes. The total possible score is 0 to 30 points; a score of 26 or above is considered normal. A positive change from Baseline (BL) indicates improvement. ANCOVA model was used for analyses that included treatment and pooled centres as factors, plus years of education and baseline MoCA score as covariates.
Time frame: Baseline, End of Infusion and Months 3, 6 and 12
Population: Participants from the Intent-to-treat population, all enrolled participants who received at least one dose of study drug, with data available for analyses at the given time-point.
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| Actovegin | Change From Baseline in Montreal Cognitive Assessment Scale (MoCA) at End of Infusion Period, Months 3, 6 and 12 | Change from BL at End of Infusion (n=242, 247) | 2.1 score on a scale | Standard Error 0.15 |
| Actovegin | Change From Baseline in Montreal Cognitive Assessment Scale (MoCA) at End of Infusion Period, Months 3, 6 and 12 | Change from Baseline at Month 3 (n=224, 234) | 3.4 score on a scale | Standard Error 0.2 |
| Actovegin | Change From Baseline in Montreal Cognitive Assessment Scale (MoCA) at End of Infusion Period, Months 3, 6 and 12 | Change from Baseline at Month 6 (n=217, 228) | 3.8 score on a scale | Standard Error 0.21 |
| Actovegin | Change From Baseline in Montreal Cognitive Assessment Scale (MoCA) at End of Infusion Period, Months 3, 6 and 12 | Change from Baseline at Month 12 (n=211, 220) | 3.9 score on a scale | Standard Error 0.25 |
| Placebo | Change From Baseline in Montreal Cognitive Assessment Scale (MoCA) at End of Infusion Period, Months 3, 6 and 12 | Change from Baseline at Month 12 (n=211, 220) | 2.9 score on a scale | Standard Error 0.24 |
| Placebo | Change From Baseline in Montreal Cognitive Assessment Scale (MoCA) at End of Infusion Period, Months 3, 6 and 12 | Change from BL at End of Infusion (n=242, 247) | 1.8 score on a scale | Standard Error 0.15 |
| Placebo | Change From Baseline in Montreal Cognitive Assessment Scale (MoCA) at End of Infusion Period, Months 3, 6 and 12 | Change from Baseline at Month 6 (n=217, 228) | 3.1 score on a scale | Standard Error 0.21 |
| Placebo | Change From Baseline in Montreal Cognitive Assessment Scale (MoCA) at End of Infusion Period, Months 3, 6 and 12 | Change from Baseline at Month 3 (n=224, 234) | 2.7 score on a scale | Standard Error 0.2 |
Change From Baseline in National Institutes of Health Stroke Scale (NIHSS) at End of Infusion Period, Months 3, 6 and 12
The NIHSS is a tool to objectively quantify the impairment caused by a stroke. The NIHSS is composed of 11 items, each of which scores a specific ability between a 0 (normal) to 4 (some level of impairment). The individual scores from each item are summed in order to calculate total possible NIHSS score from 0 (best) to 42 (worst). A negative change from Baseline indicates improvement. ANCOVA model was used for analyses that included treatment and pooled centre as factors and Baseline NIHSS score as a covariate.
Time frame: Baseline and End of Infusion and Months 3, 6 and 12
Population: Participants from the Intent-to-treat population, all enrolled participants who received at least one dose of study drug, with data available for analyses at the given time-point.
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| Actovegin | Change From Baseline in National Institutes of Health Stroke Scale (NIHSS) at End of Infusion Period, Months 3, 6 and 12 | Change from BL at End of Infusion (n=243, 248) | -1.8 score on a scale | Standard Error 0.1 |
| Actovegin | Change From Baseline in National Institutes of Health Stroke Scale (NIHSS) at End of Infusion Period, Months 3, 6 and 12 | Change from Baseline at Month 3 (n=224, 235) | -2.9 score on a scale | Standard Error 0.1 |
| Actovegin | Change From Baseline in National Institutes of Health Stroke Scale (NIHSS) at End of Infusion Period, Months 3, 6 and 12 | Change from Baseline at Month 6 (n=219, 228) | -3.2 score on a scale | Standard Error 0.1 |
| Actovegin | Change From Baseline in National Institutes of Health Stroke Scale (NIHSS) at End of Infusion Period, Months 3, 6 and 12 | Change from Baseline at Month 12 (n=211, 220) | -3.5 score on a scale | Standard Error 0.1 |
| Placebo | Change From Baseline in National Institutes of Health Stroke Scale (NIHSS) at End of Infusion Period, Months 3, 6 and 12 | Change from Baseline at Month 12 (n=211, 220) | -3.4 score on a scale | Standard Error 0.1 |
| Placebo | Change From Baseline in National Institutes of Health Stroke Scale (NIHSS) at End of Infusion Period, Months 3, 6 and 12 | Change from BL at End of Infusion (n=243, 248) | -1.7 score on a scale | Standard Error 0.1 |
| Placebo | Change From Baseline in National Institutes of Health Stroke Scale (NIHSS) at End of Infusion Period, Months 3, 6 and 12 | Change from Baseline at Month 6 (n=219, 228) | -3.2 score on a scale | Standard Error 0.1 |
| Placebo | Change From Baseline in National Institutes of Health Stroke Scale (NIHSS) at End of Infusion Period, Months 3, 6 and 12 | Change from Baseline at Month 3 (n=224, 235) | -2.7 score on a scale | Standard Error 0.1 |
EuroQol EQ-5D (EQ-5D) at Month 12
EQ-5D is a standardized measure of health status consisting of 5 dimensions: mobility, self -care, usual activities, pain/discomfort and anxiety/depression. The participant rates their level of function in each area using a 5 point scale where 1=no problems (best) to 5=extreme problems (worst). The percentage of participants in each category is reported.
Time frame: Month 12
Population: Participants from the Intent-to-treat population, all enrolled participants who received at least one dose of study drug, with data available for analyses at the given time-point.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Mobility_Moderate problem | 12.5 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Usual activities_Severe problem | 2.8 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Self-care_Moderate problem | 6.0 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Usual activities_Unable | 1.2 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Mobility_Unable | 0.8 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Pain or discomfort_No pain | 46.8 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Self-care_Severe problem | 1.6 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Pain or discomfort_Slight pain | 28.6 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Mobility_Slight problem | 31.0 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Pain or discomfort_Moderate pain | 8.5 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Self-care_Unable | 0.4 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Pain or discomfort_Severe pain | 1.6 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Self-care_No problem | 55.2 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Pain or discomfort_Extreme pain | 0 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Usual activities_No problem | 32.7 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Anxiety or depression_Not anxious | 48.4 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Mobility_Severe problem | 3.2 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Anxiety or depression_Slightly anxious | 31.5 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Usual activities_Slight problem | 39.1 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Anxiety or depression_Moderately anxious | 4.8 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Self-care_Slight problem | 22.2 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Anxiety or depression_Severely anxious | 0.8 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Usual activities_Moderate problem | 9.7 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Anxiety or depression_Extremely anxious | 0 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 12 | Mobility_No problem | 37.9 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Anxiety or depression_Extremely anxious | 0.4 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Mobility_No problem | 36.5 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Mobility_Slight problem | 29.4 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Mobility_Moderate problem | 11.8 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Mobility_Severe problem | 7.5 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Mobility_Unable | 0.8 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Self-care_No problem | 48.2 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Self-care_Slight problem | 23.5 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Self-care_Moderate problem | 9.4 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Self-care_Severe problem | 3.9 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Self-care_Unable | 0.8 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Usual activities_No problem | 31.0 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Usual activities_Slight problem | 33.7 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Usual activities_Moderate problem | 15.7 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Usual activities_Severe problem | 4.3 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Usual activities_Unable | 1.2 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Pain or discomfort_No pain | 46.7 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Pain or discomfort_Slight pain | 26.3 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Pain or discomfort_Moderate pain | 11.4 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Pain or discomfort_Severe pain | 1.2 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Pain or discomfort_Extreme pain | 0.4 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Anxiety or depression_Not anxious | 47.1 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Anxiety or depression_Slightly anxious | 27.1 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Anxiety or depression_Moderately anxious | 10.6 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 12 | Anxiety or depression_Severely anxious | 0.8 percentage of participants |
EuroQol EQ-5D (EQ-5D) at Month 6
EQ-5D is a standardized measure of health status consisting of 5 dimensions: mobility, self -care, usual activities, pain/discomfort and anxiety/depression. The participant rates their level of function in each area using a 5 point scale where 1=no problems (best) to 5=extreme problems (worst). The percentage of participants in each category is reported.
Time frame: Month 6
Population: Participants from the Intent-to-treat population, all enrolled participants who received at least one dose of study drug, with data available for analyses at the given time-point.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Self-care_Slight problem | 19.8 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Usual activities_Severe problem | 4.0 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Mobility_Severe problem | 4.0 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Usual activities_Unable | 2.0 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Self-care_Moderate problem | 7.7 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Pain or discomfort_No pain | 50.0 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Mobility_No problem | 41.5 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Pain or discomfort_Slight pain | 30.6 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Self-care_Severe problem | 2.0 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Pain or discomfort_Moderate pain | 6.0 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Mobility_Unable | 0.4 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Pain or discomfort_Severe pain | 0.8 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Mobility_Moderate problem | 12.5 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Pain or discomfort_Extreme pain | 0.4 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Usual activities_No problem | 32.7 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Anxiety or depression_Not anxious | 50.0 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Self-care_No problem | 58.5 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Anxiety or depression_Slightly anxious | 31.0 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Usual activities_Slight problem | 40.7 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Anxiety or depression_Moderately anxious | 6.0 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Mobility_Slight problem | 29.8 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Anxiety or depression_Severely anxious | 0.8 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Usual activities_Moderate problem | 8.9 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Anxiety or depression_Extremely anxious | 0.4 percentage of participants |
| Actovegin | EuroQol EQ-5D (EQ-5D) at Month 6 | Self-care_Unable | 0.4 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Anxiety or depression_Extremely anxious | 0 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Mobility_No problem | 32.2 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Mobility_Slight problem | 31.8 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Mobility_Moderate problem | 16.5 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Mobility_Severe problem | 7.1 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Mobility_Unable | 0.4 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Self-care_No problem | 48.6 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Self-care_Slight problem | 25.5 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Self-care_Moderate problem | 9.8 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Self-care_Severe problem | 3.5 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Self-care_Unable | 0.4 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Usual activities_No problem | 32.9 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Usual activities_Slight problem | 34.5 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Usual activities_Moderate problem | 17.3 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Usual activities_Severe problem | 2.5 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Usual activities_Unable | 0.8 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Pain or discomfort_No pain | 46.3 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Pain or discomfort_Slight pain | 25.5 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Pain or discomfort_Moderate pain | 15.3 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Pain or discomfort_Severe pain | 0.8 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Pain or discomfort_Extreme pain | 0 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Anxiety or depression_Not anxious | 48.2 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Anxiety or depression_Slightly anxious | 29.4 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Anxiety or depression_Moderately anxious | 9.4 percentage of participants |
| Placebo | EuroQol EQ-5D (EQ-5D) at Month 6 | Anxiety or depression_Severely anxious | 0.8 percentage of participants |
EuroQol EQ-5D (EQ-5D) General Health at Months 6 and 12
The EuroQoL included a visual analogue scale where the subject marks how they feel at that moment on a scale from 0 (the worst health that can be imagined) to 100 (the best health that can be imagined).
Time frame: Months 6 and 12
Population: Participants from the Intent-to-treat population, all enrolled participants who received at least one dose of study drug, with data available for analyses at the given time-point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Actovegin | EuroQol EQ-5D (EQ-5D) General Health at Months 6 and 12 | Month 6 (n=219, 224) | 67.3 score on a scale | Standard Deviation 16.04 |
| Actovegin | EuroQol EQ-5D (EQ-5D) General Health at Months 6 and 12 | Month 12 (n=212, 220) | 67.8 score on a scale | Standard Deviation 15.87 |
| Placebo | EuroQol EQ-5D (EQ-5D) General Health at Months 6 and 12 | Month 6 (n=219, 224) | 65.0 score on a scale | Standard Deviation 16.82 |
| Placebo | EuroQol EQ-5D (EQ-5D) General Health at Months 6 and 12 | Month 12 (n=212, 220) | 65.6 score on a scale | Standard Deviation 17.51 |
Percentage of ADAS-cog+ Responders at Time Points 3, 6 and 12 Months
Responder was defined as an improvement of 4 or more from baseline on the ADAS-cog+ scale using observed data. The proportion of responders was compared between treatments using a chi-square test.
Time frame: Baseline and Months 3, 6 and 12
Population: Participants from the Intent-to-treat population, all enrolled participants who received at least one dose of study drug, with data available for analyses at the given time-point.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Actovegin | Percentage of ADAS-cog+ Responders at Time Points 3, 6 and 12 Months | Month 3 (n=215, 223) | 59.1 percentage of responders |
| Actovegin | Percentage of ADAS-cog+ Responders at Time Points 3, 6 and 12 Months | Month 6 (n=208, 216) | 62.5 percentage of responders |
| Actovegin | Percentage of ADAS-cog+ Responders at Time Points 3, 6 and 12 Months | Month 12 (n=200, 207) | 69.0 percentage of responders |
| Placebo | Percentage of ADAS-cog+ Responders at Time Points 3, 6 and 12 Months | Month 3 (n=215, 223) | 48.9 percentage of responders |
| Placebo | Percentage of ADAS-cog+ Responders at Time Points 3, 6 and 12 Months | Month 6 (n=208, 216) | 52.3 percentage of responders |
| Placebo | Percentage of ADAS-cog+ Responders at Time Points 3, 6 and 12 Months | Month 12 (n=200, 207) | 58.9 percentage of responders |
Percentage of Participants With a Diagnosis of Dementia
Diagnosis of dementia will be evaluated after 6 and 12 months classified according to International Statistical Classification of Diseases and related Health Problems 10th Revision (ICD-10) \[Classification of Mental and Behavioural Disorders, Diagnostic Criteria for Research\]. The proportion of participants with dementia was compared between treatments using a Fisher's exact test.
Time frame: Month 6
Population: Participants from the Intent-to-treat population, all enrolled participants who received at least one dose of study drug, with data available for analyses at the given time-point.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Actovegin | Percentage of Participants With a Diagnosis of Dementia | Month 6 | 7.3 percentage of participants |
| Actovegin | Percentage of Participants With a Diagnosis of Dementia | Month 12 | 8.7 percentage of participants |
| Placebo | Percentage of Participants With a Diagnosis of Dementia | Month 6 | 10.5 percentage of participants |
| Placebo | Percentage of Participants With a Diagnosis of Dementia | Month 12 | 12.7 percentage of participants |
Percentage of Participants With a Diagnosis of Dementia
Diagnosis of dementia will be evaluated after 6 and 12 months classified according to International Statistical Classification of Diseases and related Health Problems 10th Revision (ICD-10) \[Classification of Mental and Behavioural Disorders, Diagnostic Criteria for Research\].
Time frame: Month 6 and 12
Population: Participants from the Intent-to-treat population, all enrolled participants who received at least one dose of study drug, with data available for analyses at the given time-point.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Actovegin | Percentage of Participants With a Diagnosis of Dementia | Month 6 | 7.3 percentage of participants |
| Actovegin | Percentage of Participants With a Diagnosis of Dementia | Month 12 | 8.7 percentage of participants |
| Placebo | Percentage of Participants With a Diagnosis of Dementia | Month 6 | 10.5 percentage of participants |
| Placebo | Percentage of Participants With a Diagnosis of Dementia | Month 12 | 12.7 percentage of participants |