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Peer-reviewedCC BYBMC medicine

Minocycline for acute basilar artery occlusion stroke undergoing endovascular treatment: a randomized, evaluator-blinded, open-label, pilot trial.

  • Zhirong Fan1
  • Jingjing Zhao1
  • Rui Shi1
  • Li Yao2
  • Huiping Zhang3
  • Rong Yin4
  • Weiwang Li5
  • Liping Yu6
  • Xiangjun Yuan7
  • Yi Jia8
  • Bo Song9
  • Baiya Fan10
10 more authors
  • Xingshun Ma11
  • Xue Li12
  • Deshuai Li1
  • Xiao Zhang1
  • Yang Li1
  • Ling Wang13
  • Duolao Wang14
  • Dong Wei15
  • Wen Jiang16
  • on the behalf of the MIST-B Study Group
16 affiliations
  1. 1Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
  2. 2Department of Neurology, Xi'an XD Group Hospital, Xi'an, China.
  3. 3Department of Neurology, Baoji High-tech Hospital, Baoji, China.
  4. 4Department of Neurology, Gansu Provincial Maternity and Child-care Hospital, Gansu Provincial Central Hospital), Lanzhou, China.
  5. 5Department of Neurology, Xi'an Daxing Hospital, Xi'an, China.
  6. 6Department of Neurology, The First People's Hospital of Xianyang, Xianyang, China.
  7. 7Department of Neurology, Weinan Central Hospital, Weinan, China.
  8. 8Department of Neurology, Xi'an Gaoxin Hospital, Xi'an, China.
  9. 9Department of Neurosurgery, Xianyang Hospital of Yan'an University, Xianyang, China.
  10. 10Department of Neurology, Yan'an People's Hospital, Yan'an, China.
  11. 11Department of Neurology, The First Hospital of Yulin, Yulin, China.
  12. 12Department of Neurology, Yulin Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, Yulin, China.
  13. 13Department of Health Statistics, Fourth Military Medical University, Xi'an, China.
  14. 14Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
  15. 15Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China. [email protected].
  16. 16Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China. [email protected].
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Abstract

Background

Minocycline is a promising anti-inflammatory agent for reducing futile recanalization, but whether it improves clinical outcomes in basilar-artery stroke patients treated with endovascular therapy (EVT) remains unclear. In this study, we aimed to assess the efficacy and safety of oral minocycline combined with EVT on outcomes in patients who had basilar-artery stroke.Methods

The Minocycline for acute Ischemic Stroke undergoing endovascular Treatment due to Basilar artery occlusion (MIST-B) trial was a multicenter, randomized, evaluator-blinded, open-label, pilot trial in 12 Chinese hospitals. Adults with basilar-artery stroke no more than 24 h after onset were randomized (1:1) to receive oral minocycline (200 mg loading, then 100 mg every 12 h for 5 days) plus EVT or EVT alone. The primary efficacy outcome was the expanded National Institutes of Health Stroke Scale (e-NIHSS) score at day 5; the primary safety outcome was symptomatic intracranial hemorrhage (sICH) within 24 h. Participants were followed up 90 days after randomization. Modified intention-to-treat analysis examined treatment effect for the primary efficacy outcome using linear mixed models, with the baseline measurement of e-NIHSS score as a covariate.Results

From March 4, 2023, to March 4, 2025, 90 patients were randomized, and 89 were analyzed (mean age 61.7 years, 31.5% women). At day 5, median e-NIHSS was 12.0 (IQR 3.5 to 30.0) in the minocycline group and 10.5 (IQR 2.0 to 35.0) in the control group; corresponding mean values were 15.0 (SD 13.5) and 17.2 (SD 16.9), respectively (adjusted mean difference - 2.83 [95% CI -7.86 to 2.20]; P = 0.27). sICH within 24 h occurred in 2/37 (5.4%) of participants in the minocycline group vs. 6/41 (14.6%) in the control group (adjusted risk ratio, 0.70; 95% CI, 0.11 to 4.67). Other secondary efficacy and safety outcomes, including 90-day modified Rankin Scale, mortality, and adverse events, showed no significant differences between groups.Conclusions

Minocycline was well-tolerated in this population; however, these results did not provide evidence to support prescribing minocycline to improve early neurological outcomes. Larger trials of minocycline with extended treatment duration are warranted.Registration

The trial was registered at ClinicalTrials.gov (NCT05512910) on August 23, 2022.

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Cite

BibTeXRIS
BibTeX
@article{fan2026minocycline,
  title = {{Minocycline for acute basilar artery occlusion stroke undergoing endovascular treatment: a randomized, evaluator-blinded, open-label, pilot trial.}},
  author = {Zhirong Fan and Jingjing Zhao and Rui Shi and Li Yao and Huiping Zhang and Rong Yin and Weiwang Li and Liping Yu and Xiangjun Yuan and Yi Jia and Bo Song and Baiya Fan and Xingshun Ma and Xue Li and Deshuai Li and Xiao Zhang and Yang Li and Ling Wang and Duolao Wang and Dong Wei and Wen Jiang and on the behalf of the MIST-B Study Group},
  journal = {BMC medicine},
  year = {2026},
  month = jul,
  doi = {10.1186/s12916-026-05092-4},
  url = {https://europepmc.org/article/MED/42907866},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Minocycline for acute basilar artery occlusion stroke undergoing endovascular treatment: a randomized, evaluator-blinded, open-label, pilot trial.
AU  - Zhirong Fan
AU  - Jingjing Zhao
AU  - Rui Shi
AU  - Li Yao
AU  - Huiping Zhang
AU  - Rong Yin
AU  - Weiwang Li
AU  - Liping Yu
AU  - Xiangjun Yuan
AU  - Yi Jia
AU  - Bo Song
AU  - Baiya Fan
AU  - Xingshun Ma
AU  - Xue Li
AU  - Deshuai Li
AU  - Xiao Zhang
AU  - Yang Li
AU  - Ling Wang
AU  - Duolao Wang
AU  - Dong Wei
AU  - Wen Jiang
AU  - on the behalf of the MIST-B Study Group
PY  - 2026
DA  - 2026/07/01
JO  - BMC medicine
DO  - 10.1186/s12916-026-05092-4
UR  - https://europepmc.org/article/MED/42907866
AB  - Background  Minocycline is a promising anti-inflammatory agent for reducing futile recanalization, but whether it improves clinical outcomes in basilar-artery stroke patients treated with endovascular therapy (EVT) remains unclear. In this study, we aimed to assess the efficacy and safety of oral minocycline combined with EVT on outcomes in patients who had basilar-artery stroke.Methods  The Minocycline for acute Ischemic Stroke undergoing endovascular Treatment due to Basilar artery occlusion (MIST-B) trial was a multicenter, randomized, evaluator-blinded, open-label, pilot trial in 12 Chinese hospitals. Adults with basilar-artery stroke no more than 24 h after onset were randomized (1:1) to receive oral minocycline (200 mg loading, then 100 mg every 12 h for 5 days) plus EVT or EVT alone. The primary efficacy outcome was the expanded National Institutes of Health Stroke Scale (e-NIHSS) score at day 5; the primary safety outcome was symptomatic intracranial hemorrhage (sICH) within 24 h. Participants were followed up 90 days after randomization. Modified intention-to-treat analysis examined treatment effect for the primary efficacy outcome using linear mixed models, with the baseline measurement of e-NIHSS score as a covariate.Results  From March 4, 2023, to March 4, 2025, 90 patients were randomized, and 89 were analyzed (mean age 61.7 years, 31.5% women). At day 5, median e-NIHSS was 12.0 (IQR 3.5 to 30.0) in the minocycline group and 10.5 (IQR 2.0 to 35.0) in the control group; corresponding mean values were 15.0 (SD 13.5) and 17.2 (SD 16.9), respectively (adjusted mean difference - 2.83 [95% CI -7.86 to 2.20]; P = 0.27). sICH within 24 h occurred in 2/37 (5.4%) of participants in the minocycline group vs. 6/41 (14.6%) in the control group (adjusted risk ratio, 0.70; 95% CI, 0.11 to 4.67). Other secondary efficacy and safety outcomes, including 90-day modified Rankin Scale, mortality, and adverse events, showed no significant differences between groups.Conclusions  Minocycline was well-tolerated in this population; however, these results did not provide evidence to support prescribing minocycline to improve early neurological outcomes. Larger trials of minocycline with extended treatment duration are warranted.Registration  The trial was registered at ClinicalTrials.gov (NCT05512910) on August 23, 2022.
SN  - 1741-7015
ER  -