WSC 2023 | ESCAPE-NEXT yields neutral results for nerinetide treatment in acute ischemic stroke

Michael D. Hill, MD, University of Calgary, Alberta, Canada, presents results from the Phase III ESCAPE-NEXT (NCT04462536) trial, which assessed the efficacy of nerinetide in improving outcomes for patients with acute ischemic stroke. Nerinetide is a neuroprotective molecule that acts by inhibiting post-synaptic density protein 95 (PSD-95). Patients were randomly assigned to receive nerinetide or saline control following the onset of acute stroke, followed by a 90-day assessment period. The study hypothesized that nerinetide was better than control at improving acute stroke outcomes, based on the previous results from the ESCAPE-NA1 trial (NCT02930018). However, the ESCAPE-NEXT trial yielded neutral outcomes, failing to establish nerinetide as superior in improving stroke outcomes. Interestingly, the percentage of patients categorized as having a good recovery after stroke was approximately 10% less than what was predicted based on the ESCAPE-NA1 trial. Dr Hill wonders if this could be explained by the COVID19 pandemic, ongoing throughout the trial. The timing of intervention appeared to influence the outcome, with the effect size in favor of nerinetide when patients were treated earlier. It is possible that the trial’s patient population was too far into the acute stroke phase for nerinetide to exert its full efficacy. This interview took place at the World Stroke Congress (WSC) 2023 in Toronto, Canada.

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