Clomethiazole has been marketed for several years as a
sedative/
antiepileptic. Astra is now developing it for the potential treatment of
stroke. An NDA is expected to be filed in 1999/2000. A North American phase III trial for large
stroke has commenced. This will include 1200 patients. Two other smaller scale phase III studies with
clomethiazole have also commenced in North America for
intracerebral hemorrhage (n=200) and safety in combination with TPA (n=100 to 200) (Genentech). A large-scale phase III trial has been completed in which
clomethiazole was evaluated for its ability to reduce nerve damage in acute cerebrovascular
ischemia. The multicenter, international trial, called CLASS (
Clomethiazole Acute Stroke Study), analyzed 1360 patients and found no significant treatment effect. However, a subgroup of patients who presented with large
stroke, experienced a significant benefit. Of these (n=545), 41% treated patients were functionally independent after 90 days, compared to 30% patients on placebo.
Clomethiazole reduced functional disability and brain damage in the marmoset permanent MCAO model.
Clomethiazole is thought to act through a GABAergic pathway, whereby it augments
GABA's depressive effect on the CNS, giving the
drug both
hypnotic and
neuroprotectant properties.