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Background and study aims
Stroke affects nearly 100,000 people in the UK every year, and only half of all stroke survivors make a full recovery. Rehabilitation leads to improvements in many cases, but it is possible that other treatments can improve recovery even further. One such treatment is Erythropoietin (EPO), which is a purified artificially produced hormone that stimulates the growth of stem cells, especially in the bone marrow, which leads to an increase in the production of red blood cells. It also stimulates the growth of other stem cells involved in repair and some studies have suggested that it may increase brain repair in patients who have suffered stroke. EPO has been used routinely for several years to treat anaemia. The aim of this study is to find out if treatment with EPO, together with rehabilitation further improves recovery.

Who can participate?
Men and women aged between 18 and 85 years who are approached to take part within 48 hours of having a stroke, and do not already have a significant disability.

What does the study involve?
Eligible patients undergo a comprehensive MR imaging for blood flow, concentration of different chemicals and connections across the brain. Following this, patients are randomly allocated to one of three groups. The control group receive standard of care treatment with therapists and the rehabilitation team. The second group receive the drug erythropoietin (EPO) on three occasions injected into the vein on days 1, 3 and 5. The third group receive the drug rhEPO injected into the vein on days 7, 14 and 21. Patients are monitored for 1 week after the treatment with clinical examination and blood tests. The EPO injection is not given if blood tests show too much blood is being produced. Further analyses are made 30 and 90 days after being included in the study. A further MRI scan of the head is done to assess recovery.

What are the possible benefits and risks of participating?
A possible individual benefit of being treated with EPO cannot be stated at this point in time but the results of the study will contribute to a better public knowledge about the best treatment for rehabilitation after a stroke. Like most drugs, EPO could cause some side effects or an allergic reaction. The most common side effects include a rise in blood pressure, headache, nausea and joint pains which occur in about 1 in 10 patients especially at the start of treatment. About 1 in 100 patients show an increase in the number of platelets that can increase the risk of clots. Other side effects include diarrhoea, flu-like illness, rash, and vomiting which may occur in 1-2 in 100 patients. Allergic reactions are rare and include rash, itching, and very rarely swelling of the tongue and mouth.

Where is the study run from?
The study is run from King’s College Hospital NHS Foundation Trust and the Department of Clinical Neurosciences, King’s College London (UK)

When is the study starting and how long is it expected to run for?
November 2012 to May 2014

Who is funding the study?
National Institute for Health Research (NIHR) (UK)

The research will show whether EPO treatment given early or late during stroke recovery has the potential to improve recovery in stroke patients who have not been thrombolysed. If EPO is shown to have the potential to influence brain repair, information from the study will be used to design larger definitive clinical trials for translation into clinical use in 35 years.

Randomised trial

Start dates may differ between countries and research sites. The research team are responsible for keeping the information up-to-date.  

The recruitment start and end dates are as follows:

Interventional

Intervention Type : Drug
Intervention Description : The research will be undertaken in three groups of 30 stroke patients each who are within 48 hours of stroke onset, have not been thrombolysed and have no contraindications to EPO treatment. All groups will receive best usual treatment consisting of structured multidisciplinary rehabilitation on a stroke unit. In addition, participants in the second group will receive EPO 40,000 IU given intravenously at 1, 3 and 5 days and those in the third group will receive EPO 40,000 IU/ given intravenously at 7, 14, 21 days. The differences in recovery between the groups will be assessed at 30 and 90 days after randomisation by measuring clinical recovery in function and changes in the brain perfusion and structure using magnetic resonance (MR) imaging.

You can take part if:

1. Supratentorial ischaemic stroke, confirmed on imaging2. Recruited within 48 hours of stroke onset. Time of onset is when symptoms began; for stroke that occurred during sleep, time of onset is when patient was last seen or was selfreported to be normal3. NIHSS score 624 with NIHSS 1A (level of consciousness) score <2 at the time of enrolment4. Reasonable expectation of availability to receive the full course of therapy, and to be available for subsequent follow-up visits5. Reasonable expectation that patient will receive standard poststroke physical, occupational and speech therapy as indicated

You may not be able to take part if:

1. Prestroke modified Rankin Score (mRS) >22. Thrombolytic treatment with tPA following the index stroke3. Patients presenting with hemorrhagic and/or brain stem stroke4. Women who may be pregnant or breastfeeding5. Serum hemoglobin > 16 g/dL (males) or > 14 g/dL (females), or platelet count > 400,000/mm36. Advanced liver, kidney, cardiac or pulmonary disease (serum bilirubin > 1.5 x upper limit of normal (ULN), Alkaline phosphatase > 2.5 x ULN, GGT>2.5xULN7. History of clotting disorders8. Expected survival < 1 year9. Allergy or other contraindication to erythropoeitin as per SPMC10. A known diagnosis of cancer (except nonmalignant skin cancer)11. A known diagnosis of epilepsy12. Uncontrolled hypertension (BP persistently > 220 mm Hg systolic or 120 mm Hg diastolic despite antihypertensive therapy)13. Preexisting and active major psychiatric or other chronic neurological disease14. Currently participating in another investigational study

Below are the locations for where you can take part in the trial. Please note that not all sites may be open.

• King's College Hospital NHS Trust
  London
  SE5 9PJ
  

Prof Lalit Kalra
-
lalit.kalra@kcl.ac.uk

The study is sponsored by King's College Hospital NHS Foundation Trust (UK) and funded by National Institute for Health Research (NIHR) - Central Commissioning Facility (UK) .