Neurology, distilled.

Test whether combining clopidogrel-aspirin dual antiplatelet therapy with immediate intensive statin further reduces 90-day new stroke risk in acute mild ischemic stroke or high-risk TIA of presumed atherosclerotic cause, using a 2x2 factorial design.

Combination of clopidogrel-aspirin + immediate intensive statin lowered 90-day new stroke vs aspirin + delayed statin: 7.6% vs 9.9% (HR 0.76, 95% CI 0.60-0.97; ARR 2.2%, NNT 45)

Test whether intensive blood pressure lowering (SBP <140 mm Hg) for 24 hours after successful endovascular thrombectomy in acute ischemic stroke has durable effects on functional outcome and mortality at 1 year, compared with conventional management (SBP 140–180 mm Hg).

Functional independence (mRS 0–2) at 1 year was lower with intensive vs conventional BP management: 40.5% vs 52.7% (ITT adj OR 0.59, 95% CI 0.34–1.00, P=0.051; per-protocol 41.1% vs 54.7%, adj OR 0.56, 95% CI 0.32–0.97, P=0.040)

Assess whether baseline CT markers of cerebral small vessel disease (cSVD), as a surrogate for brain frailty, explain the reduced benefit of mechanical thrombectomy observed in elderly patients enrolled in the RESILIENT trial in Brazil.

Mechanical thrombectomy benefit was concentrated in patients <70 years with low cSVD burden (OR 4.16, 95% CI 1.6-10.4, p<0.01)

Evaluate 2-year (and 3-year subset) retention of upper-extremity motor gains after paired vagus nerve stimulation (VNS) plus rehabilitation in chronic ischemic stroke.

FMA-UE improved 7.51 points from baseline at 2 years (95% CI 5.80–9.22; p<0.001)

To compare the efficacy and safety of 1-month versus 12-month dual antithrombotic therapy (DOAC plus P2Y12 inhibitor) followed by DOAC monotherapy after percutaneous coronary intervention in patients with atrial fibrillation.

1-month dual antithrombotic therapy was non-inferior to 12-month therapy for the composite of all-cause death or thromboembolic events at 12 months (5.4% vs 4.3%; absolute difference 1.1 percentage points [95% CI −1.5 to 3.6]; HR 1.25 [95% CI 0.73–2.17]; non-inferiority margin 5.0 percentage points)

To evaluate the safety, tolerability, and pharmacokinetics of vamorolone (2 or 6 mg/kg/d) in corticosteroid-naive boys with Duchenne muscular dystrophy aged 2-<4 years, with exploratory motor efficacy.

No deaths, no serious TEAEs, and no treatment discontinuations over 12 weeks; TEAEs more frequent with 6 mg/kg/d (90%) vs 2 mg/kg/d (70%), most commonly GI events and infections

To determine whether rituximab is noninferior to ocrelizumab for suppressing disease activity in adults with newly diagnosed relapsing multiple sclerosis.

Rituximab was noninferior to ocrelizumab for absence of new/enlarging T2 lesions from month 6-24 (92.2% vs 94.8%; risk difference -2.6 percentage points, 95% CI -9.4 to 4.3; P=0.03 for noninferiority)

To assess the safety and efficacy of oral levacetylleucine (N-acetyl-L-leucine) for the neurological manifestations of ataxia-telangiectasia in paediatric and adult patients.

First positive phase 3 RCT in ataxia-telangiectasia: levacetylleucine reduced SARA total score by −1·92 vs −0·14 with placebo (linear mixed model treatment effect −1·88, 95% CI −2·70 to −1·06; p<0·0001), exceeding the minimally important 1–1·5-point threshold.