Cytoflavin in the Complex Rehabilitation of Stroke Patients

A Multicenter, Double-blind, Placebo-controlled, Randomized Study of the Efficacy and Safety of Sequential Therapy With CYTOFLAVIN® (NTFF POLYSAN, Russia), Solution for Intravenous Infusion and Enteric-coated Tablets, in the Complex Rehabilitation of Patients With Acute Stroke

It is known that the acute period of stroke occurs is accompanied by oxidative stress, when intense generation of reactive oxygen species (ROS) have a toxic effect, which causes oxidative degradation of proteins, lipids, nucleic acids. Antioxidants may have a positive effect on the processes of reparation, remodeling and neuroplasticity, thus improving the effectiveness of post-stroke rehabilitation. The adjunctive use of drug therapy that improves neuroplasticity may promote accelerated motor learning, which underlies the effects of exercise therapy and physical therapy, speech therapy, and sessions with a psychologist or occupational therapist. CYTOFLAVIN® is a combination of succinic acid, riboflavin, nicotinamide and inosine (riboxin) which has antihypoxic and antioxidant effects. The study hypothetizes that this neurometabolic drug will facilitate learning in stroke survivors and help to acquire new cognitive or motor skills necessary for daily living. The study will be conducted in two parallel groups of stroke survivors: the experimental group will be treated with Cytoflavin along with ohysical rehabilitation, the control group will receive standard rehabilitation course.

Study Overview

• Status: Completed
• Conditions: Stroke
• Intervention / Treatment: Drug: Cytoflavin (Inosine + Nicotinamide + Riboflavin + Succinic Acid); Drug: Placebo

• Study Type: Interventional
• Enrollment (Actual): 240
• Phase: Phase 3

Contacts and Locations

Study Locations

• Russia
  • Saint Petersburg, Russia
    • City General Hospital №2
  • Saint Petersburg, Russia
    • City Hospital №40 of the Kurortny District
  • Saint Petersburg, Russia
    • Saint-Petersburg I.I.Dzanelidze Research Institute of Emergency Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Signed Patient informed consent form
2. Men and women aged 40 to 80, inclusive.
3. Ischemic stroke in the carotid area, or hemorrhagic stroke in the cerebral hemispheres, occurred in the previous 14-90 days before screening.
4. Acute neuroimaging data (CT and/or MRI) do not contradict the clinical and topical diagnosis of stroke.
5. The presence of a measurable neurological deficit in the motor or sensory area.
6. Availability of rehabilitation potential, which is assessed by the specialists of the multidisciplinary team
7. Modified Rankin score 3-4.
8. The possibility to visit outpatient rehabilitation at the research center.
9. Ability to understand and comply with protocol requirements.
10. For women: consent to use reliable methods of contraception or absent reproductive potential.
11. For men: consent to the use of adequate methods of contraception, or complete abstinence from sexual activity for the period of the study, or absent reproductive potential.

Exclusion Criteria:

1. Known hypersensitivity to any component of the study drug
2. Severe visual and hearing impairments that prevent the implementation of study procedures.
3. Severe spasticity (scored 3-4 by Ashworth scale).
4. Impaired swallowing, which does not allow taking drugs orally.
5. Communication deficit that does not allow the patient to fulfill the conditions of the study protocol (including total aphasia).
6. The presence of contraindications to complex rehabilitation in a hospital (lack of rehabilitation potential, somatic diseases that prevent a complex of rehabilitation measures).
7. Aneurysmal subarachnoid hemorrhage.
8. Previous (before the actual ictus) stroke with residual neurological deficit.
9. Disability is primarily not attributed to the last stroke
10. Severe renal failure
11. Severe liver failure
12. End stage of other chronic incurable diseases.
13. Decompensated diabetes mellitus.
14. History of cancer, mental illness, HIV infection, syphilis, tuberculosis, alcohol, drug or drug addiction.
15. Established diagnosis of a mental or neurodegenerative disease
16. Constant use of psychotropic drugs (neuroleptics, tranquilizers, antidepressants) or nootropic drugs in the previous 3 months before the patient was included in the study, except for stroke treatment in acute hospital.
17. Alcohol or drug addiction

19. Pregnancy, lactation.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Placebo	Drug: Placebo; Placebo, 20 ml (two ampoules of 10 ml each) once a day intravenously in a dilution of 200 ml of 0.9% sodium chloride solution at a rate 3-4 ml / min, for 15 days + Placebo, 2 tablets 2 times a day, for 25 days
Experimental: Cytoflavin	Drug: Cytoflavin (Inosine + Nicotinamide + Riboflavin + Succinic Acid); Cytoflavin (Inosine + Nicotinamide + Riboflavin + Succinic Acid), 20 ml (two ampoules of 10 ml each) once a day intravenously in a dilution of 200 ml of 0.9% sodium chloride solution at a rate 3-4 ml/min, for 15 days + Cytoflavin ((Inosine + Nicotinamide + Riboflavin + Succinic Acid), 2 tablets 2 times a day, for 25 days

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change of performance	Change at the performance subscale (range 0-10, higher=better) of Canadian Occupational Performance Measure (COPM) score after completion of therapy compared to baseline	40 days

Collaborators and Investigators

• Sponsor: POLYSAN Scientific & Technological Pharmaceutical Company
• Investigators: Study Director: Alexey Shmonin, Prof, First St. Petersburg State Medical University named after I.P. Pavlov

Study record dates

Study Major Dates

• Study Start (Actual): June 30, 2023
• Primary Completion (Actual): June 26, 2024
• Study Completion (Actual): December 7, 2024

Study Registration Dates

• First Submitted: June 28, 2023
• First Submitted That Met QC Criteria: June 28, 2023
• First Posted (Actual): July 7, 2023

Study Record Updates

• Last Update Posted (Actual): April 14, 2026
• Last Update Submitted That Met QC Criteria: April 9, 2026
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Keywords: stroke rehabilitation
• Additional Relevant MeSH Terms: Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Stroke; Organic Chemicals; Pyridines; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Nucleic Acids, Nucleotides, and Nucleosides; Pigments, Biological; Biological Factors; Acids, Acyclic; Carboxylic Acids; Enzymes and Coenzymes; Purines; Nucleosides; Ribonucleosides; Pteridines; Coenzymes; Heterocyclic Compounds, 3-Ring; Purine Nucleosides; Acids, Heterocyclic; Nicotinic Acids; Dicarboxylic Acids; Flavins; Succinates; Niacinamide; Riboflavin; Inosine; cytoflavin; Succinic Acid
• Other Study ID Numbers: CTF-III-SR-2022

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No