XILO-FIST
Research type
Research Study
Full title
Xanthine oxidase inhibition for improvement of long-term outcomes following ischaemic stroke and transient ischaemic attack (XILO-FIST).
IRAS ID
142409
Contact name
Jesse Dawson
Contact email
Sponsor organisation
NHS Greater Glasgow and Clyde,
Eudract number
2013-004235-77
Research summary
Summary of Research
Recurrent stroke and cognitive decline are common after ischaemic stroke. Allopurinol, a drug usually used to treat gout, has been shown to reduce heart ischaemia, heart size, and arterial stiffness and to relax brain blood vessels and may reduce the blood pressure. All of these properties may be associated with a lower risk of second stroke and cognitive decline. We now aim to explore whether allopurinol will reduce further damage to the brain (called white matter hyper-intensities) after stroke and also whether it reduces heart size and blood pressure after stroke.
We will conduct a multi-centre randomised, double-blind placebo controlled study to investigate whether two years allopurinol 300 mg twice per day (BD) improves these 3 outcomes, which are inextricably linked to risk of recurrence and cognitive decline after ischaemic stroke.
Summary of Results
People who suffer a stroke caused by blockage in an artery are at risk of suffering further strokes, and also have an increased risk of heart attacks. High levels of uric acid, which cause the arthritis gout, might be related to increased risk. Allopurinol, a drug we use to lower uric acid in gout may therefore reduce stroke risk.
We did a trial where we compared the effect of allopurinol with a placebo tablet in people with a stroke due to arterial blockage or a mini stroke in the last 30 days. In the study everyone had a detailed brain MRI scan at the beginning and after two years treatment. We also did detailed measurements of blood pressure. Our main measures in the study were the change in the amount of damage caused by disease in the small blood vessels of the brain on MRI (called white matter hyperintensities) at two years, and the change in level of blood pressure at 4 weeks.
We randomised 464 participants (232 in each of the allopurinol and placebo groups). A total of 372 (189 with placebo and 183 with allopurinol) attended for both the MRI scans and were included in the main analysis. There was no difference in the amount of white matter hyperintensities between allopurinol and placebo. Blood pressure was reduced with allopurinol compared to placebo after 4 weeks, by 3 mmHg.
Allopurinol use did not reduce the amount of white matter hyperintensities but did lower blood pressure by a small amount. We conclude it is unlikely allopurinol will reduce risk of stroke, but further research should see if there are people who have a big reduction in blood pressure.REC name
West of Scotland REC 1
REC reference
14/WS/0113
Date of REC Opinion
24 Jun 2014
REC opinion
Further Information Favourable Opinion