GLP-1 may have potential to improve poststroke outcomes, prognosis
Key takeaways:
- Liraglutide may improve outcomes and prognosis after minor stroke/transient ischemic attack in patients with diabetes.
- However, the trial was halted prematurely and the data should be interpreted with caution.
The GLP-1 liraglutide showed potential benefit in reducing stroke recurrence and improving functional outcomes after minor stroke or transient ischemic attack, a speaker reported.
However, the LAMP study, presented at the International Stroke Conference, was terminated early due to slow enrollment and cost.
“Diabetes increases the [incidence] and recurrence of stroke by two to four times. But insulin or sulfonylurea-based treatment for glycemic control did not reduce the risk of microvascular complications such as myocardial infarction and ischemic stroke. Even with 3 weeks of dual antiplatelet therapy, 12.8% of diabetic patients with minor acute ischemic stroke experienced recurrence within 90 days,” Hui-Li Zhu, MD, associate professor at The First Affiliated Hospital of Jinan University, Guangzhou, China, said during a presentation. “Liraglutide is a synthetic long-acting GLP-1 receptor agonist, and has the ability to cross the blood-brain barrier. Our previous study showed liraglutide decreased the infarct volume and improved neurologic deficits in a rat model of [middle cerebral artery] occlusion. ... Both basic research and clinical studies have suggested that GLP-1 receptor agonists may have the potential to improve stroke recurrence and prognosis.”
LAMP was a multicenter, randomized controlled, prospective trial designed to evaluate the efficacy and safety of liraglutide (Victoza/Saxenda, Novo Nordisk) for the prevention of recurrent stroke after minor ischemic stroke or high-risk TIA in patients with diabetes.
The LAMP study was terminated early due to a lower-than-expected enrollment and financial constraints, which prevented completion within the planned timeframe or target sample size, according to the presentation.
Overall, 636 patients hospitalized with minor ischemic stroke or high-risk TIA within 24 hours of symptom onset were included in the study and were randomly assigned to liraglutide or usual care.
Individuals assigned to liraglutide were provided ascending daily doses of the drug, starting with 0.6 mg and rising to 1.8 mg by day 30.
The primary endpoint was occurrence of new strokes within 90 days of index stroke.
Baseline characteristics were balanced between the liraglutide and usual care groups (mean age, 64 years; 36% women; 91% with history of diabetes; mean baseline HbA1c, 8.2%). The average BMI was approximately 24 kg/m2 and one-third of patients were currently smoking.
Subsequent new stroke occurred in 13.8% of the usual care arm compared with 7.9% of the liraglutide arm, which in the intention-to-treat analysis translated to a hazard ratio of 0.56 favoring liraglutide (95% CI, 0.34-0.91; P = .02). However, due to insufficient sample size, statistical power was only 67%.
In secondary analysis, the researchers reported that after minor ischemic stroke or high-risk TIA, individuals with diabetes assigned to liraglutide were more likely to achieve a modified Rankin score of 1 or less at 90 days compared with usual care (OR = 1.95; 95% CI, 1.28-3; P = .002). Similarly, liraglutide was associated with greater likelihood to achieve a modified Rankin score of 2 or less compared with usual care (OR = 1.77; 95% CI, 1.06-3.02; P = .032).
“Among Chinese patients with minor acute ischemic stroke or high-risk TIA who were diagnosed with type 2 diabetes, treatment with liraglutide probably reduced the risk of stroke recurrence and improved outcomes at 90 days,” Zhu said during the presentation. “Careful interpretation of these early terminated study results is warranted, and additional research is required to confirm these potential benefits. The LAMP study is the first and largest-scale trial investigating GLP-1 receptor agonists in patients with ischemic stroke, offering some valuable insights into their potential benefits for improving patient outcomes.”
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Zhu H, et al. LB44. Presented at: International Stroke Conference; Feb. 5-7, 2025; Los Angeles (hybrid meeting).
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