Can the use of allopurinol after stroke reduce the progression of white matter hyperintensity?

In a randomized trial, the use of allopurinol did not reduce the progression of white matter hyperintensity (WMH) in patients with ischemic stroke or transient ischemic attack (TIA)
.

The study showed that the difference in the Rotterdam Progression Score (RPS) between patients who received the xanthine oxidase inhibitor allopurinol and those who received a placebo was 0.
17, which was not statistically significant
.

Yimaitong compiles and organizes, please do not reprint without authorization
.

Research Introduction Previous studies have shown that elevated serum uric acid levels are associated with the risk of adverse cardiovascular outcomes (including stroke)
.

Xanthine oxidase inhibitors can lower blood uric acid levels and therefore may affect the risk of stroke
.

A meta-analysis of a small study showed that allopurinol can lower blood pressure to a certain extent, and may reduce the risk of cardiovascular events in patients with confirmed cardiovascular disease
.

 Based on the above findings, the researchers conducted a study on whether allopurinol can reduce WMH progression (a marker of stroke risk) and blood pressure after ischemic stroke or TIA
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Researchers recruited patients 50 years of age or older at 22 locations in the UK
.

 After a four-week run-in period, the researchers randomly assigned the participants to receive 300 mg of allopurinol or placebo twice a day for 104 weeks
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All participants received brain MRI at baseline and 104 weeks, and ambulatory blood pressure monitoring was performed at baseline, 4 weeks, and 104 weeks
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 The researchers chose to use the WMH progress measured by RPS as the main result of the study
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Secondary results include the average daytime systolic blood pressure at Week 4 and Week 104
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 Main findings: ➤Overall, 189 participants in the placebo group and 183 participants in the allopurinol group underwent MRI examinations at the 104th week
.

The RPS of the allopurinol group was 1.
33 and that of the placebo group was 1.
51
.

The difference between the groups was -0.
17, which was not statistically significant
.

 ➤At the 4th week, the daytime systolic blood pressure change in the allopurinol group was -2.
3mmHg, the placebo group was 0.
8mmHg, and the difference between the groups was -3.
33mmHg (P=0.
0034)
.

In the 104th week, there was a significant loss of follow-up
.

At that time, the inter-group difference in daytime systolic blood pressure was -2.
95 mmHg (P=0.
058)
.

 Expert comment Louis R.
Caplan, MD, professor of neurology at Harvard Medical School in Boston, Massachusetts, said that this study “re-causes people's attention to uric acid, but there are many paradoxes about uric acid
.

” Epidemiological studies show that uric acid levels are high.
Of people are at increased risk of stroke
.

But other data suggests that uric acid may have a positive effect
.

A 2016 study showed that uric acid treatment can prevent early ischemic exacerbations in acute stroke patients receiving thrombolytic therapy
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There is a lack of correlation between WMH and neurological deficits.
WMH is not an infarction.
It is difficult to know what the changes on MRI really mean
.

 Study author Jesse Dawson, MD, professor of stroke medicine at the University of Glasgow, UK, said: “We were surprised that we did not see a difference in RPS between the allopurinol group and the placebo group
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However, we recognize that WMH may have many other causes, not just It is the flexibility of the cerebrovascular
.
The
lack of effect is consistent with the very complex pathophysiology of WMH that we know to exist
.

"Yimaitong compiled from: No Reduction in WMH Progression With Allopurinol After Stroke-Medscape-Nov 15, 2021.