MLC601 in vascular dementia: an efficacy and safety pilot study

Hossein Pakdaman, Ali Amini Harandi, Koroush Gharagozli, Mehdi Abbasi, Majid Ghaffarpour, Farzad Ashrafi, Hosein Delavar Kasmaei, Asghar Amini Harandi, Hossein Pakdaman, Ali Amini Harandi, Koroush Gharagozli, Mehdi Abbasi, Majid Ghaffarpour, Farzad Ashrafi, Hosein Delavar Kasmaei, Asghar Amini Harandi

Abstract

Background and aim: Vascular dementia (VaD) is the second most common cause of dementia and currently there is scarcity of therapies for VaD. We aimed to investigate the efficacy and safety of MLC601 in the treatment of VaD.

Methods: In this multicenter, pilot, randomized, double-blind trial, 82 patients with VaD according to DSM-5 criteria received MLC601 or placebo capsules three times a day for 2 years. The primary efficacy end-point was evaluated by comparing Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) score between the two groups over 2 years of study. Safety was also assessed by recording adverse events and abnormal laboratory results.

Results: Eighty-one patients completed the study and were included in the analysis. One patient was lost to follow-up in the placebo group. After 2 years, mean (±SD) changes in the MMSE score were -3.71 (±4.50) for MLC601 group and -9.33 (±4.80) for placebo group. ADAS-cog score showed (±SD) changes of 7.34 (±9.55) and 19.00 (±11.28) for MLC601 and placebo group, respectively. Repeated measures analyses showed that both MMSE and ADAS-cog scores were significantly better in the treatment group at 24 months (p<0.001). Ten (24.39%) patients reported predominantly transient gastrointestinal adverse events in MLC601 group. No patient left the study due to adverse events. There were no clinically significant abnormalities on laboratory tests.

Conclusion: Patients treated with MLC601 over the 2 years showed dramatically better cognitive outcome compared with those treated with placebo. MLC601 was devoid of any serious adverse events and was well-tolerated.

Keywords: MLC601; randomized placebo-controlled trial; safety; vascular dementia.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Study flowchart.
Figure 2
Figure 2
Mean changes in MMSE score in the MLC601 and placebo groups. 95% confidence interval for difference (2.16 to 4.73). Abbreviation: MMSE, Mini-Mental State Examination.
Figure 3
Figure 3
Mean changes in ADAS-cog scores in the MLC601 and placebo groups. 95% confidence interval for difference (−8.87 to −3.70). Abbreviation: ADAS-cog, Alzheimer’s Disease Assessment Scale-cognitive subscale.

References

    1. Fratiglioni L, Launer L, Andersen K, et al. Incidence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology. 1999;54(11):S10–S15.
    1. Lobo A, Launer L, Fratiglioni L, et al. Prevalence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurology. 2000;54(11):S4–S9.
    1. Ott A, Breteler MM, Van Harskamp F, et al. Prevalence of Alzheimer’s disease and vascular dementia: association with education. The Rotterdam study. BMJ. 1995;310(6985):970–973.
    1. Baskys A, Hou AC. Vascular dementia: pharmacological treatment approaches and perspectives. Clin Interv Aging. 2007;2(3):327–335.
    1. Kalaria RN, Ballard C. Overlap between pathology of Alzheimer disease and vascular dementia. Alzheimer Dis Assoc Discord. 1999;13:S115–S123.
    1. van Charante EPM, Richard E, Eurelings LS, et al. Effectiveness of a 6-year multidomain vascular care intervention to prevent dementia (preDIVA): a cluster-randomised controlled trial. The Lancet. 2016;388(10046):797–805.
    1. Perry EK, Tomlinson BE, Blessed G, Bergmann K, Gibson PH, Perry RH. Correlation of cholinergic abnormalities with senile plaques and mental test scores in senile dementia. Br Med J. 1978;2(6150):1457–1459.
    1. Narasimhalu K, Effendy S, Sim C, et al. A randomized controlled trial of rivastigmine in patients with cognitive impairment no dementia because of cerebrovascular disease. Acta Neurol Scand. 2010;121(4):217–224.
    1. Kavirajan H, Schneider LS. Efficacy and adverse effects of cholinesterase inhibitors and memantine in vascular dementia: a meta-analysis of randomised controlled trials. Lancet Neurol. 2007;6(9):782–792.
    1. Orgogozo J-M, Rigaud A-S, Stöffler A, Möbius H-J, Forette F. Efficacy and safety of memantine in patients with mild to moderate vascular dementia. Stroke. 2002;33(7):1834–1839.
    1. Heurteaux C, Gandin C, Borsotto M, et al. Neuroprotective and neuroproliferative activities of NeuroAid (MLC601, MLC901), a Chinese medicine, in vitro and in vivo. Neuropharmacology. 2010;58(7):987–1001.
    1. Harandi A, Abolfazli R, Hatemian A, et al. Safety and efficacy of MLC601 in Iranian patients after stroke: a double-blind, placebo-controlled clinical trial. Stroke Res Treat. 2011;2011
    1. Harandi AA, Ashrafi F, Tabatabaei M, et al. Efficacy and tolerability of MlC601 in patients with mild to moderate Alzheimer disease who were unable to tolerate or failed to benefit from treatment with rivastigmine. British Journal of Medicine and Medical Research. 2013;3(2):341.
    1. Pakdaman H, Harandi AA, Hatamian H, et al. Effectiveness and safety of MLC601 in the treatment of mild to moderate Alzheimer’s disease: a multicenter, randomized controlled trial. Demtn Geriatr Cogn Dis Extra. 2015;5(1):96–106.
    1. Pakdaman H, Amini Harandi A, Abbasi M, et al. Efficacy and Safety of MLC601 in the treatment of mild cognitive impairment: a pilot, randomized, double-blind, placebo-controlled study. Dement Geriatr Cogn Dis Extra. 2017;7(1):136–142.
    1. Venketasubramanian N, Young SH, Tay SS, et al. Chinese medicine NeuroAiD efficacy on stroke recovery-extension study (CHIMES-E): A multicenter study of long-term efficacy. Cerebrovasc Dis. 2015;39(5–6):309–318.
    1. Chen CL, Ikram K, Anqi Q, et al. The NeuroAiD II (MLC901) in vascular cognitive impairment study (NEURITES) Cerebrovasc Dis. 2013;35(1):23–29.
    1. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–198.
    1. Weyer G, Erzigkeit H, Kanowski S, Ihl R, Hadler D. Alzheimer’s Disease Assessment Scale: reliability and validity in a multicenter clinical trial. Int Psychogeriatr. 1997;9(02):123–138.
    1. Quintard H, Lorivel T, Gandin C, Lazdunski M, Heurteaux C. MLC901, a traditional Chinese medicine induces neuroprotective and neuroregenerative benefits after traumatic brain injury in rats. Neuroscience. 2014;277:72–86.
    1. Lorivel T, Gandin C, Veyssière J, Lazdunski M, Heurteaux C. Positive effects of the traditional Chinese medicine MLC901 in cognitive tasks. J Neurosci Res. 2015;93(11):1648–1663.
    1. Erkinjuntti T, Kurz A, Gauthier S, Bullock R, Lilienfeld S, Damaraju CV. Efficacy of galantamine in probable vascular dementia and Alzheimer’s disease combined with cerebrovascular disease: a randomised trial. The Lancet. 2002;359(9314):1283–1290.
    1. Auchus A, Brashear H, Salloway S, et al. Galantamine treatment of vascular dementia A randomized trial. Neurology. 2007;69(5):448–458.
    1. Wilkinson D, Doody R, Helme R, et al. Donepezil in vascular dementia A randomized, placebo-controlled study. Neurology. 2003;61(4):479–486.
    1. Wilcock G, Möbius HJ, Stöffler A, MMM 500 Group A double-blind, placebo-controlled multicentre study of memantine in mild to moderate vascular dementia (MMM500) Int Clin Psychopharmacol. 2002;17(6):297–305.
    1. Siddiqui FJ, Venketasubramanian N, Chan E-Y, Chen C. Efficacy and safety of MLC601 (NeuroAiD®), a traditional Chinese medicine, in poststroke recovery: a systematic review. Cerebrovasc Dis. 2013;35(1):8–17.
    1. Pendlebury ST, Rothwell PM. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol. 2009;8(11):1006–1018.
    1. Agüero-Torres H, Winblad B. Alzheimer’s disease and vascular dementia: some points of confluence. Ann N Y Acad Sci. 2000;903(1):547–552.

Source: PubMed

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