Developments in Brief : Study Finds Stroke Drug Ineffective

A drug used to treat patients stricken by the third-most-common type of stroke is apparently ineffective and may do more harm than good, a new report cautions. The study is the first to carefully evaluate the drug’s effectiveness even though it has been used routinely for years.

The study, published in the current issue of the New England Journal of Medicine, found that patients who suffered cerebral hemorrhages were just as likely to die whether or not they received dexamethasone.

In addition, patients who received the drug were more likely to develop complications, especially infections, according to the study’s authors from the Siriraj Hospital Medical Center in Bangkok, Thailand.

“The drug should probably not be used for this purpose. It doesn’t do any good. And it looks like it does more harm than good,” said Dr. Brian L. Strom of the University of Pennsylvania in Philadelphia, who helped conduct the analysis. “It’s the standard textbook recommended way of treating this, but (it) has never been evaluated in a rigorous, controlled study.”

About 10% of all strokes are cerebral hemorrhages in which a blood vessel bursts in the brain. The two most common causes of strokes are thrombosis, a blood clot in the brain, and embolus, a clot that forms elsewhere in the body and causes a stroke when it reaches the brain.

Dexamethasone was recommended to treat the strokes because it reduces swelling and doctors thought it would alleviate pressure in the brain. But Strom said the drug apparently is ineffective for this type of swelling and increases the chances of infection by depressing the immune system.

The study involved 93 patients who suffered cerebral hemorrhages. Forty-six received the drug and 47 did not. In each group, 21 patients died.

Further studies may identify a subgroup of patients who benefit from the drug, Strom said. But until that occurs, doctors should refrain from using it, he said.