ISC 2025 | Emerging approaches for the secondary prevention of stroke: anti-inflammatory therapies and more

It was a kind of like a roundtable and presentations around the next frontiers in ischemic stroke prevention and management. So there were multiple topics so I have the pleasure and the honor to present the next frontiers in anti-inflammatory therapies. So the reason I think I was given this presentation is because there is a huge unmet need right so even with the available treatments that we have right now and even for the treatments that they’re coming up improving antiplatelet agents and also diabetic medications and lipidemic agents there will still be an unmet need in ischemic stroke and hemorrhagic stroke survivors. The reality is that people after an ischemic or hemorrhagic stroke they have a higher risk of a stroke recurrence but also major adverse cardiovascular events including a myocardial infarction and cardiovascular death. So many people despite being on the best treatments that we have available they still have those events. So what we have found out for decades now is that inflammation is involved in all stages of atherosclerosis and we have the first evidence coming in from the CANTOS trial showing that we can intervene on inflammation and reduce the risk of cardiovascular events. So in my presentation, I’m presenting how we can use it for stroke prevention. I presented an overview of the recent trials that they use colchicine and their outcomes, but more importantly, what are the next steps and how we can improve the outcomes of our patients by targeting inflammation and the inflammatory pathways. Yeah, so if we’re able to show that inflammation can reduce the risk of stroke recurrence and more importantly in secondary stroke prevention this will change a whole new landscape right so it’s going to be like opening a Pandora’s box but in a nice way not in a negative way, because then you know I think we’ll be able to target a more let’s say pathways in the inflammatory cascade and ameliorate inflammation and improve our patient outcomes. We need to say that we haven’t been successful so far. So I presented the two trials with colchicine, CHANCE-3 which was a totally neutral trial, CONVINCE which was a neutral trial, but with some signs of hope and some exploratory analysis that were predefined, that they give some promise that it’s a hypothesis that we should not abandon. We should test further and whether it’s colchicine or other agents I don’t think we should drop the inflammatory hypothesis just based on the results of those two trials. There were many different approaches so my colleagues highlighted on the upcoming trials that they’re going to be presented hopefully soon about factor XI inhibitors and if they’re positive of course this is going to be a game changer. Of course, the other big thing is the control of lipidemia. And so, people presented the utility of PCSK9 inhibitors, which unfortunately are underutilized in stroke patients. And also, last but not least, what was brought up was antidiabetic agents and more specifically, GLP-1 receptor agonists. We have data from those medications that can improve cardiovascular outcomes and specifically they can be used to prevent strokes from happening. Again, unfortunately these are drugs that they haven’t penetrated so much clinical practice and in terms of secondary stroke prevention they’re also underutilized and not used as broadly as they should.

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