Preventing cognitive decline and dementia from cerebral small vessel disease: The LACI-1 Trial. Protocol and statistical analysis plan of a phase IIa dose escalation trial testing tolerability, safety and effect on intermediary endpoints of isosorbide mononitrate and cilostazol, separately and in combination
Rationale The pathophysiology of most lacunar stroke, a form of small vessel disease, is thought to differ from large artery atherothrombo- or cardio-embolic stroke. Licensed drugs, isosorbide mononitrate and cilostazol, have promising mechanisms of action to support their testing to prevent stro...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
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Sage
2018
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| Online Access: | https://eprints.nottingham.ac.uk/47047/ |
| _version_ | 1848797455586426880 |
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| author | Blair, Gordon W. Appleton, Jason P. Law, Zhe Kang Doubal, Fergus Flaherty, Katie Dooley, Richard Shuler, Kirsten Richardson, Carla Hamilton, Iona Shi, Yulu Stringer, Michael Boyd, Julia Thrippleton, Michael J. Sprigg, Nikola Bath, Philip M.W. Wardlaw, Joanna M. |
| author_facet | Blair, Gordon W. Appleton, Jason P. Law, Zhe Kang Doubal, Fergus Flaherty, Katie Dooley, Richard Shuler, Kirsten Richardson, Carla Hamilton, Iona Shi, Yulu Stringer, Michael Boyd, Julia Thrippleton, Michael J. Sprigg, Nikola Bath, Philip M.W. Wardlaw, Joanna M. |
| author_sort | Blair, Gordon W. |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Rationale
The pathophysiology of most lacunar stroke, a form of small vessel disease, is thought to differ from large artery atherothrombo- or cardio-embolic stroke. Licensed drugs, isosorbide mononitrate and cilostazol, have promising mechanisms of action to support their testing to prevent stroke recurrence, cognitive impairment, or radiological progression after lacunar stroke.
Aim
LACI-1 will assess the tolerability, safety, and efficacy, by dose, of isosorbide mononitrate and cilostazol, alone and in combination, in patients with ischemic lacunar stroke.
Sample size
A sample of 60 provides 80+% power (significance 0.05) to detect a difference of 35% (90% versus 55%) between those reaching target dose on one versus both drugs.
Methods and design
LACI-1 is a phase IIa partial factorial, dose-escalation, prospective, randomized, open label, blinded endpoint trial. Participants are randomized to isosorbide mononitrate and/or cilostazol for 11 weeks with dose escalation to target as tolerated in two centers (Edinburgh, Nottingham). At three visits, tolerability, safety, blood pressure, pulse wave velocity, and platelet function are assessed, plus magnetic resonance imaging to assess cerebrovascular reactivity in a subgroup.
Study outcomes
Primary: proportion of patients completing study achieving target maximum dose.
Secondary
Symptoms whilst taking medications; safety (hemorrhage, recurrent vascular events, falls); blood pressure, platelet function, arterial stiffness, and cerebrovascular reactivity.
Discussion
This study will inform the design of a larger phase III trial of isosorbide mononitrate and cilostazol in lacunar stroke, whilst providing data on the drugs’ effects on vascular and platelet function. |
| first_indexed | 2025-11-14T20:04:09Z |
| format | Article |
| id | nottingham-47047 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T20:04:09Z |
| publishDate | 2018 |
| publisher | Sage |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-470472020-05-04T19:43:19Z https://eprints.nottingham.ac.uk/47047/ Preventing cognitive decline and dementia from cerebral small vessel disease: The LACI-1 Trial. Protocol and statistical analysis plan of a phase IIa dose escalation trial testing tolerability, safety and effect on intermediary endpoints of isosorbide mononitrate and cilostazol, separately and in combination Blair, Gordon W. Appleton, Jason P. Law, Zhe Kang Doubal, Fergus Flaherty, Katie Dooley, Richard Shuler, Kirsten Richardson, Carla Hamilton, Iona Shi, Yulu Stringer, Michael Boyd, Julia Thrippleton, Michael J. Sprigg, Nikola Bath, Philip M.W. Wardlaw, Joanna M. Rationale The pathophysiology of most lacunar stroke, a form of small vessel disease, is thought to differ from large artery atherothrombo- or cardio-embolic stroke. Licensed drugs, isosorbide mononitrate and cilostazol, have promising mechanisms of action to support their testing to prevent stroke recurrence, cognitive impairment, or radiological progression after lacunar stroke. Aim LACI-1 will assess the tolerability, safety, and efficacy, by dose, of isosorbide mononitrate and cilostazol, alone and in combination, in patients with ischemic lacunar stroke. Sample size A sample of 60 provides 80+% power (significance 0.05) to detect a difference of 35% (90% versus 55%) between those reaching target dose on one versus both drugs. Methods and design LACI-1 is a phase IIa partial factorial, dose-escalation, prospective, randomized, open label, blinded endpoint trial. Participants are randomized to isosorbide mononitrate and/or cilostazol for 11 weeks with dose escalation to target as tolerated in two centers (Edinburgh, Nottingham). At three visits, tolerability, safety, blood pressure, pulse wave velocity, and platelet function are assessed, plus magnetic resonance imaging to assess cerebrovascular reactivity in a subgroup. Study outcomes Primary: proportion of patients completing study achieving target maximum dose. Secondary Symptoms whilst taking medications; safety (hemorrhage, recurrent vascular events, falls); blood pressure, platelet function, arterial stiffness, and cerebrovascular reactivity. Discussion This study will inform the design of a larger phase III trial of isosorbide mononitrate and cilostazol in lacunar stroke, whilst providing data on the drugs’ effects on vascular and platelet function. Sage 2018-07-01 Article PeerReviewed Blair, Gordon W., Appleton, Jason P., Law, Zhe Kang, Doubal, Fergus, Flaherty, Katie, Dooley, Richard, Shuler, Kirsten, Richardson, Carla, Hamilton, Iona, Shi, Yulu, Stringer, Michael, Boyd, Julia, Thrippleton, Michael J., Sprigg, Nikola, Bath, Philip M.W. and Wardlaw, Joanna M. (2018) Preventing cognitive decline and dementia from cerebral small vessel disease: The LACI-1 Trial. Protocol and statistical analysis plan of a phase IIa dose escalation trial testing tolerability, safety and effect on intermediary endpoints of isosorbide mononitrate and cilostazol, separately and in combination. International Journal of Stroke, 13 (5). pp. 530-538. ISSN 1747-4949 Lacunar stroke Small vessel disease Cilostazol Isosorbide mononitrate Endothelium Blood–brain barrier White matter hyperintensities Cerebrovascular reactivity https://doi.org/10.1177/1747493017731947 doi:10.1177/1747493017731947 doi:10.1177/1747493017731947 |
| spellingShingle | Lacunar stroke Small vessel disease Cilostazol Isosorbide mononitrate Endothelium Blood–brain barrier White matter hyperintensities Cerebrovascular reactivity Blair, Gordon W. Appleton, Jason P. Law, Zhe Kang Doubal, Fergus Flaherty, Katie Dooley, Richard Shuler, Kirsten Richardson, Carla Hamilton, Iona Shi, Yulu Stringer, Michael Boyd, Julia Thrippleton, Michael J. Sprigg, Nikola Bath, Philip M.W. Wardlaw, Joanna M. Preventing cognitive decline and dementia from cerebral small vessel disease: The LACI-1 Trial. Protocol and statistical analysis plan of a phase IIa dose escalation trial testing tolerability, safety and effect on intermediary endpoints of isosorbide mononitrate and cilostazol, separately and in combination |
| title | Preventing cognitive decline and dementia from cerebral small vessel disease: The LACI-1 Trial. Protocol and statistical analysis plan of a phase IIa dose escalation trial testing tolerability, safety and effect on intermediary endpoints of isosorbide mononitrate and cilostazol, separately and in combination |
| title_full | Preventing cognitive decline and dementia from cerebral small vessel disease: The LACI-1 Trial. Protocol and statistical analysis plan of a phase IIa dose escalation trial testing tolerability, safety and effect on intermediary endpoints of isosorbide mononitrate and cilostazol, separately and in combination |
| title_fullStr | Preventing cognitive decline and dementia from cerebral small vessel disease: The LACI-1 Trial. Protocol and statistical analysis plan of a phase IIa dose escalation trial testing tolerability, safety and effect on intermediary endpoints of isosorbide mononitrate and cilostazol, separately and in combination |
| title_full_unstemmed | Preventing cognitive decline and dementia from cerebral small vessel disease: The LACI-1 Trial. Protocol and statistical analysis plan of a phase IIa dose escalation trial testing tolerability, safety and effect on intermediary endpoints of isosorbide mononitrate and cilostazol, separately and in combination |
| title_short | Preventing cognitive decline and dementia from cerebral small vessel disease: The LACI-1 Trial. Protocol and statistical analysis plan of a phase IIa dose escalation trial testing tolerability, safety and effect on intermediary endpoints of isosorbide mononitrate and cilostazol, separately and in combination |
| title_sort | preventing cognitive decline and dementia from cerebral small vessel disease: the laci-1 trial. protocol and statistical analysis plan of a phase iia dose escalation trial testing tolerability, safety and effect on intermediary endpoints of isosorbide mononitrate and cilostazol, separately and in combination |
| topic | Lacunar stroke Small vessel disease Cilostazol Isosorbide mononitrate Endothelium Blood–brain barrier White matter hyperintensities Cerebrovascular reactivity |
| url | https://eprints.nottingham.ac.uk/47047/ https://eprints.nottingham.ac.uk/47047/ https://eprints.nottingham.ac.uk/47047/ |