Afghanistan and the Future of Stroke Treatment

The treatment of stroke was revolutionized in 1996 when the FDA approved a clot-dissolving drug, alteplase (tPA). It remains our only available medical treatment for the most common type of stroke, although several types of drugs have been studied over the years. Alteplase (tPA) is not ideal, however, and in some cases produces only limited benefit. The search for more effective drugs continues.

In last week’s edition of The New England Journal of Medicine, one of the world’s most prestigious medical journals, a group of investigators from Australia published a study investigating another clot dissolving drug for stroke, tenecteplase (TNK). This study can be viewed as preliminary (phase IIB), and applies to only those patients studied, who were selected by very strict criteria following special CT scan exams, known as CT angiography and CT perfusion. Over 2700 patients were screened to find 75 eligible for the study. The bottom line is that tenecteplase was better than alteplace at opening clogged arteries, and the patients treated with tenecteplase had better clinical results. Tenecteplase, like alteplace before it, is currently FDA approved for the treatment of myocardial infarction.

The path for tenecteplase to reach stroke patients in the United States would need to first include a phase III clinical trial to determine efficacy in the much larger group of patients that are currently eligible for alteplase, rather than the selected group in this study.

It will not be easy. A trial studying tenecteplase in the United States, sponsored by the National Institutes of Health, was performed between 2006 and 2008. It was stopped early because the number of patients being recruited was considered too low to continue. While our country is spending $2 billion per week on the war in Afghanistan, funding for studies on stroke treatment is difficult to come by.

Stroke is a common, devastating condition. We have a potentially more effective treatment with a drug that has been developed for another use. A new clinical trial needs to be conducted in the United States. Whether the money comes from the government, industry, private philanthropy or a combination, this type of work must be supported by all of us.

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