After stroke, promising treatments limit the risk of hemorrhage and death

In France, 140,000 strokes occur each year, of which 40,000 lead to death and 30,000 severely disable people. One in five people will have a stroke in their lifetime and this pathology, which occurs so suddenly that we often forget, is the leading cause of death in women.

Every minute counts when treating a stroke because the faster it is done, the less the patient will suffer from its after effects. In this race against time, the most common treatment for acute ischemic stroke (cerebral infarction), which represents 80% of strokes, is thrombolysis. It involves the intravenous injection of a drug that blocks blood clots in arteries and restricts blood circulation. Thrombolysis should be done within four and a half hours. In addition, we perform a thrombectomy which involves inserting a catheter into the artery up to the cerebral artery and then deploying a type of net (Stent retrieval

) which will catch and expel the clot.

But one of the complications of this treatment lies in the risk of bleeding. Acticor Biotech, a start-up from Inserm, has been working for years on glanzimab, a monoclonal antibody that binds to a protein involved in clot formation (platelet glycoprotein VI, GPVI). This drug prevents its formation, but without increasing the risk of bleeding. “That was the initial idea for this start-up, Explains Gilles Avenard, former hematologist, general director and founder of Actor Biotech. And the main indication of this research is obviously stroke in which the risk of intracerebral hemorrhage is very high. » In 2018, a phase 1 result showed that this molecule reduced platelet activation in animals and humans with healthy volunteers, without increasing the risk of bleeding.

Phase 2 trials were conducted between 2019 and 2021. its results Lancet Neurology By Mikel Mazighi, Head of the Department of Neurology at Lariboisière Hospital (AP-HP).

Mortality cut in half

In detail, the double-blind, placebo-controlled, randomized Actimis study included 166 patients with ischemic stroke, spread across six European countries, all of whom were treated with thrombolysis and/or thrombectomy, plus glanzumab for about half of them. The primary objective was to assess its tolerability. Then its effectiveness. “Two things surprised us. The first is that the group treated with glanzomab had less bleeding than the group not treated with this drug. Second: This reduction in cerebral hemorrhage leads to a reduction in severe disability as well as mortality., Gilles Avenard suggests. The mortality rate of treated patients was cut in half compared to the placebo group, from 19% to just 8%. “The best results were seen in the oldest patients – more than 40% were over 80 years of age. And, in this age group, the mortality rate is divided by four”

, That makes it clear.

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