Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/34442
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dc.contributor.authorBladin, Christopher F-
dc.contributor.authorWah Cheung, Ngai-
dc.contributor.authorDewey, Helen M-
dc.contributor.authorChurilov, Leonid-
dc.contributor.authorMiddleton, Sandy-
dc.contributor.authorThijs, Vincent N-
dc.contributor.authorEkinci, Elif I-
dc.contributor.authorLevi, Christopher R-
dc.contributor.authorLindley, Richard-
dc.contributor.authorDonnan, Geoffrey A-
dc.contributor.authorParsons, Mark W-
dc.contributor.authorMeretoja, Atte-
dc.contributor.authorTiainen, Marjaana-
dc.contributor.authorChoi, Philip M C-
dc.contributor.authorCordato, Dennis-
dc.contributor.authorBrown, Helen-
dc.contributor.authorCampbell, Bruce C V-
dc.contributor.authorDavis, Stephen M-
dc.contributor.authorCloud, Geoffrey-
dc.contributor.authorGrimley, Rohan-
dc.contributor.authorLee-Archer, Matthew-
dc.contributor.authorGhia, Darshan-
dc.contributor.authorSanders, Lauren-
dc.contributor.authorMarkus, Romesh-
dc.contributor.authorMuller, Claire-
dc.contributor.authorSalvaris, Patrick-
dc.contributor.authorWu, Teddy-
dc.contributor.authorFink, John-
dc.date2023-
dc.date.accessioned2023-12-13T05:24:55Z-
dc.date.available2023-12-13T05:24:55Z-
dc.date.issued2023-12-
dc.identifier.citationStroke 2023-12; 54(12)en_US
dc.identifier.issn1524-4628-
dc.identifier.urihttps://ahro.austin.org.au/austinjspui/handle/1/34442-
dc.description.abstractHyperglycemia in acute ischemic stroke reduces the efficacy of stroke thrombolysis and thrombectomy, with worse clinical outcomes. Insulin-based therapies are difficult to implement and may cause hypoglycemia. We investigated whether exenatide, a GLP-1 (glucagon-like peptide-1) receptor agonist, would improve stroke outcomes, and control poststroke hyperglycemia with minimal hypoglycemia. The TEXAIS trial (Treatment With Exenatide in Acute Ischemic Stroke) was an international, multicenter, phase 2 prospective randomized clinical trial (PROBE [Prospective Randomized Open Blinded End-Point] design) enrolling adult patients with acute ischemic stroke ≤9 hours of stroke onset to receive exenatide (5 µg BID subcutaneous injection) or standard care for 5 days, or until hospital discharge (whichever sooner). The primary outcome (intention to treat) was the proportion of patients with ≥8-point improvement in National Institutes of Health Stroke Scale score (or National Institutes of Health Stroke Scale scores 0-1) at 7 days poststroke. Safety outcomes included death, episodes of hyperglycemia, hypoglycemia, and adverse event. From April 2016 to June 2021, 350 patients were randomized (exenatide, n=177, standard care, n=173). Median age, 71 years (interquartile range, 62-79), median National Institutes of Health Stroke Scale score, 4 (interquartile range, 2-8). Planned recruitment (n=528) was stopped early due to COVID-19 disruptions and funding constraints. The primary outcome was achieved in 97 of 171 (56.7%) in the standard care group versus 104 of 170 (61.2%) in the exenatide group (adjusted odds ratio, 1.22 [95% CI, 0.79-1.88]; P=0.38). No differences in secondary outcomes were observed. The per-patient mean daily frequency of hyperglycemia was significantly less in the exenatide group across all quartiles. No episodes of hypoglycemia were recorded over the treatment period. Adverse events of mild nausea and vomiting occurred in 6 (3.5%) exenatide patients versus 0 (0%) standard care with no withdrawal. Treatment with exenatide did not reduce neurological impairment at 7 days in patients with acute ischemic stroke. Exenatide did significantly reduce the frequency of hyperglycemic events, without hypoglycemia, and was safe to use. Larger acute stroke trials using GLP-1 agonists such as exenatide should be considered. URL: www.australianclinicaltrials.gov.au; Unique identifier: ACTRN12617000409370. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03287076.en_US
dc.language.isoeng-
dc.subjectexenatideen_US
dc.subjecthyperglycemiaen_US
dc.subjectischemic strokeen_US
dc.subjectstrokeen_US
dc.subjectthrombectomyen_US
dc.titleManagement of Poststroke Hyperglycemia: Results of the TEXAIS Randomized Clinical Trial.en_US
dc.typeJournal Articleen_US
dc.identifier.journaltitleStrokeen_US
dc.identifier.affiliationDepartment of Neurosciences, Eastern Health and Eastern Health Clinical School, Department of Neurology, Monash University, Clayton, Victoria, Australia (C.F.B., H.M.D., P.M.C.C.).;The Florey Institute of Neuroscience and Mental Health (C.F.B., V.T., B.C.V.C.), University of Melbourne, Parkville, Australia.en_US
dc.identifier.affiliationFaculty of Medicine and Health, Westmead Hospital (N.W.C.), University of Sydney, New South Wales, Australia.en_US
dc.identifier.affiliationDepartment of Neurosciences, Eastern Health and Eastern Health Clinical School, Department of Neurology, Monash University, Clayton, Victoria, Australia (C.F.B., H.M.D., P.M.C.C.).en_US
dc.identifier.affiliationDepartment of Medicine (L.C.), University of Melbourne, Parkville, Australia.;Australian Centre for Accelerating Diabetes Innovations (L.C., E.E.), University of Melbourne, Parkville, Australia.en_US
dc.identifier.affiliationNursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia (S.M.).en_US
dc.identifier.affiliationThe Florey Institute of Neuroscience and Mental Health (C.F.B., V.T., B.C.V.C.), University of Melbourne, Parkville, Australia.en_US
dc.identifier.affiliationAustralian Centre for Accelerating Diabetes Innovations (L.C., E.E.), University of Melbourne, Parkville, Australia.;Austin Health, Australia (L.C., E.E.).en_US
dc.identifier.affiliationDepartment of Neurology, Priority Research Centre for Brain and Mental Health Research, John Hunter Hospital, University of Newcastle, Newcastle, Australia (C.R.L.).en_US
dc.identifier.affiliationFaculty of Medicine and Health, Sydney Medical School (R.L.), University of Sydney, New South Wales, Australia.;George Institute for Global Health, Sydney, Australia (R.L.).en_US
dc.identifier.affiliationDepartment of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital (G.A.D., B.C.V.C., S.M.D), University of Melbourne, Parkville, Australia.en_US
dc.identifier.affiliationDepartment of Neurology, Ingham Institute for Applied Medical Research, Liverpool Hospital, University of New South Wales, Sydney, Australia (M.W.P., D.C.).en_US
dc.identifier.affiliationAustin Healthen_US
dc.identifier.affiliationDepartment of Neurology, Helsinki University Hospital, Finland (A.M., M.T.).en_US
dc.identifier.affiliationDepartment of Neurosciences, Eastern Health and Eastern Health Clinical School, Department of Neurology, Monash University, Clayton, Victoria, Australia (C.F.B., H.M.D., P.M.C.C.).en_US
dc.identifier.affiliationDepartment of Neurology, Ingham Institute for Applied Medical Research, Liverpool Hospital, University of New South Wales, Sydney, Australia (M.W.P., D.C.).en_US
dc.identifier.affiliationPrincess Alexandra Hospital, Brisbane, Queensland, Australia (H.B.).en_US
dc.identifier.affiliationThe Florey Institute of Neuroscience and Mental Health (C.F.B., V.T., B.C.V.C.), University of Melbourne, Parkville, Australia.;Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital (G.A.D., B.C.V.C., S.M.D), University of Melbourne, Parkville, Australia.en_US
dc.identifier.affiliationDepartment of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital (G.A.D., B.C.V.C., S.M.D), University of Melbourne, Parkville, Australia.en_US
dc.identifier.affiliationSchool of Medicine and Dentistry, Griffith University, Birtinya, Queensland, Australia (R.G.).en_US
dc.identifier.affiliationDepartment of Neurology, Launceston General Hospital, Tasmania, Australia (M.L.-A.).en_US
dc.identifier.affiliationDepartment of Neurology, Fiona Stanley Hospital, Perth, Western Australia, Australia (D.G.).en_US
dc.identifier.affiliationDepartment of Neurosciences, St Vincent's Hospital, Melbourne, Australia (L.S.).en_US
dc.identifier.affiliationDepartment of Neurology, St Vincent's Hospital, Sydney, Australia (R.M.).en_US
dc.identifier.affiliationDepartment of Neurology, Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Australia (C.M.).en_US
dc.identifier.affiliationDepartment of Medicine, St John of God Midland Public and Private Hospitals, Perth, Western Australia (P.S.).en_US
dc.identifier.affiliationDepartment of Neurology, Christchurch Hospital, New Zealand (T.W., J.F.).en_US
dc.identifier.doi10.1161/STROKEAHA.123.044568en_US
dc.type.contentTexten_US
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dc.identifier.pubmedid38011235-
dc.description.volume54-
dc.description.issue12-
dc.description.startpage2962-
dc.description.endpage2971-
dc.subject.meshtermssecondaryExenatide/therapeutic use-
dc.subject.meshtermssecondaryIschemic Stroke/complications-
dc.subject.meshtermssecondaryStroke/complications-
dc.subject.meshtermssecondaryStroke/drug therapy-
dc.subject.meshtermssecondaryHyperglycemia/drug therapy-
dc.subject.meshtermssecondaryHyperglycemia/complications-
dc.subject.meshtermssecondaryHypoglycemia/complications-
dc.subject.meshtermssecondaryGlucagon-Like Peptide 1/therapeutic use-
item.fulltextNo Fulltext-
item.openairecristypehttp://purl.org/coar/resource_type/c_18cf-
item.cerifentitytypePublications-
item.languageiso639-1en-
item.grantfulltextnone-
item.openairetypeJournal Article-
crisitem.author.deptMedicine (University of Melbourne)-
crisitem.author.deptThe Florey Institute of Neuroscience and Mental Health-
crisitem.author.deptNeurology-
crisitem.author.deptThe Florey Institute of Neuroscience and Mental Health-
crisitem.author.deptEndocrinology-
crisitem.author.deptThe Florey Institute of Neuroscience and Mental Health-
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