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Choline Precursors Lower Stroke Death and Disability Rates, Meta-analysis Indicates: Presented at ISC

By Bruce Sylvester

Special to DG News

SAN ANTONIO, TX -- February 11 -- A meta-analysis of placebo-controlled clinical trials suggest a substantial benefit of treatment with choline precursors for patients with ischemic or haemorrhagic stroke.

Results from the Cochrane Stroke Review Group analysis were presented on Feb. 7 by Jeffrey Saver, MD, at the 27^th International Stroke Conference, in San Antonio, Texas.

"The studies show a substantial positive effect of choline therapy for these patients," said Dr. Saver, associate professor of neurology at UCLA School of Medicine in Los Angeles, Los Angeles, California, and spokesperson for the review group. "We found an absolute reduction of 10 percent and 12 percent in long-term death and disability rates, respectively."

Choline precursors are a group of molecules that get converted to phospholipids in the brain. Phospholipids perform many functions, including serving as crucial nerve cell membrane components and acting as neurotransmitters. Choline precursors include drugs like lecithin and citicoline.

Researchers examined data from seven controlled trials that enrolled a total of 1,963 patients. Subjects had received choline precursors orally or intravenously at a dose ranging from 500 to 2,000 mg/day. Treatment with choline precursors was initiated within 14 days of onset of ischemic or haemorrhagic stroke.

Across all studies, treatment with choline precursors significantly reduced rates of death and disability at long-term follow-up (p<0.00001). Death and disability rate was 54.6 (611/1119) percent for patients treated with choline precursors compared to 66.4 (561/844) percent for those on placebo. Analysis of the four largest trials (n>100) produced a smaller but still highly significant treatment effect-54.8 (574/1048) percent for choline precursor-treated subjects compared to 64.7 (500/773) percent for the placebo group (p=0.0003). Safety analysis at end of follow-up revealed that treatment with choline precursors had no adverse effect on mortality. Adverse effects occurred in 14.8 (164/1106) percent of treated subjects and 15.2 (127/834) percent of placebo subjects (p=0.6).

Dr. Saver suggested that choline precursors might improve ischemic brain damage in two ways, by neuroprotection or by enhancement of neurorepair processes. He reported that in previous animal studies, choline precursors appeared to limit injury to nerve cell membranes, possibly by quickly replacing the damaged membrane components. He also said that in the same studies, choline precursors appeared to help repair damaged nerve cells and stimulate the development of new connections between nerve cells.

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