Edinburgh Imaging

21 Apr 20. Featured Paper

Protocol: The Lacunar Intervention Trial 2 (LACI-2). A trial of two repurposed licenced drugs to prevent progression of cerebral small vessel disease.

Link to paper on SAGE journals



Joanna Wardlaw, Philip M W Bath, Fergus Doubal, Anna Heye, Nikola Sprigg, Lisa J Woodhouse, Gordon Blair, Jason Appleton, Vera Cvoro, Timothy England, Ahamad Hassan, David John Werring, Alan Montgomery, The LACI-2 Trial Investigators



Background: Small vessel disease causes a quarter of ischaemic strokes (lacunar subtype), up to 45% of dementia either as vascular or mixed types, cognitive impairment & physical frailty.

However, there is no specific treatment to prevent progression of small vessel disease.

Aim: We designed the LACunar Intervention Trial-2 (LACI-2) to test feasibility of a large trial testing cilostazol &/or isosorbide mononitrate (ISMN) by demonstrating adequate participant recruitment & retention in follow-up, drug tolerability, safety & confirm outcome event rates required to power a phase 3 trial.

Methods & design: LACI-2 is an investigator-initiated, prospective randomised open label blinded endpoint (PROBE) trial aiming to recruit 400 patients with prior lacunar syndrome due to a small subcortical infarct.

We randomise participants to cilostazol v no cilostazol & ISMN or no ISMN, minimising on key prognostic factors.

All patients receive guideline-based best medical therapy.

Patients commence trial drug at low dose, increment to full dose over 2–4 weeks, continuing on full dose for a year.

We follow-up participants to one year for symptoms, tablet compliance, safety, recurrent vascular events, cognition & functional outcomes, Trails B & brain MRI. LACI-2 is registered ISRCTN 14911850, EudraCT 2016–002277-35.

Trial outcome: Primary outcome is feasibility of recruitment & compliance; secondary outcomes include safety (cerebral or systemic bleeding, falls, death), efficacy (recurrent cerebral & cardiac vascular events, cognition on TICS, Trails B) & tolerability.

Summary: LACI-2 will determine feasibility, tolerability & provide outcome rates to power a large phase 3 trial to prevent progression of cerebral small vessel disease.