New in Neurology: Colchicine, GLP-1s, and Physiotherapy vs Psychotherapy in Motor Disorders

Prof Christoph Diener discusses recent neurology updates in stroke care, sleep apnea, antipsychotics and dementia, and how to best treat motor disorders.
https://www.medscape.com/viewarticle/...

-- TRANSCRIPT --
Dear colleagues, I'm Christoph Diener from the Faculty of Medicine at the University of Duisburg-Essen in Germany. I would like to propose for reading for you five studies in neurology, which were published in June 2024.

Let me start with secondary stroke prevention. We all know that the most important causes of a secondary stroke are changes in the thrombotic system, but inflammatory processes also play an important role in recurrent stroke. Colchicine has shown anti-inflammatory properties and efficacy in secondary prevention of coronary heart disease.

Colchicine, GLP-1s
Therefore, the CONVINCE trial, published in The Lancet, investigated whether this drug could be effective in secondary stroke prevention. The study compared, in an open-label trial, 0.5-mg colchicine per day plus usual care vs usual care alone. The primary endpoint was fatal and nonfatal recurrent ischemic stroke, myocardial infarction, cardiac arrest, or hospitalization for unstable angina.
The study included 3154 patients with minor stroke or high-risk transient ischemic attack (TIA). The primary endpoint was shown in 9.8% in the colchicine group and 11.7% in the usual-care group. This difference was not significant. This was also true for recurrent ischemic strokes, where there was no difference.

There are two problems with the study. Number one, there was no placebo. The other problem is that the study had to be interrupted due to COVID-19 and did not achieve the planned number of endpoints.

The second study deals with a new substance group of dual gastric inhibitory polypeptides and glucagon-like 1 peptide (GLP-1) receptor agonists. Tirzepatide is one of them. This drug is approved for the treatment of type 2 diabetes and obesity. We all know that obstructive sleep apnea is associated with obesity.

There were two double-blind, randomized, phase 3 studies performed in patients with moderate to severe obstructive sleep apnea syndrome and obesity, published in The New England Journal of Medicine. The first study only included people not receiving positive airway pressure therapy. The second study included only patients receiving positive airway pressure therapy.

The dose of tirzepatide was 10 mg or 15 mg once a week subcutaneously or placebo for 1 year. The primary endpoint was the so-called apnea index, which measures the number of apnea phases during 1 hour at sleep. At baseline, this was, on average, 50 apnea phases per hour. The body mass index in both studies was around 38.

During treatment, there were 20 fewer events per hour in study one and 24 fewer events for study two for tirzepatide compared with placebo. There were also significant differences in all secondary endpoints, such as reduction in body weight as well as improvement in sleep disturbances, systolic blood pressure, and C-reactive protein. In most, probably, this drug will also get an indication to treat sleep apnea syndrome in people with obesity.

My third study is very interesting because it discusses the possible mechanism of GLP-1 receptor agonists for the treatment of obesity and diabetes, published in JAMA. There might be effects beyond simply the metabolic effects via the dopaminergic reward system. Perhaps this could be a drug that could be used to treat dependency, for example, smoking cessation without consecutive weight gain or alcohol and cocaine dependence. There are a number of ongoing studies.

Other indications for GLP-1 receptor agonists are Parkinson's disease and Alzheimer's disease. We have already some promising results for Parkinson's disease, so it will be very interesting to look at the results of the ongoing studies.

Antipsychotics and Dementia
My next study comes from the United Kingdom. This is a population-based cohort study investigating the use of antipsychotic substances in patients with dementia. This study was conducted over 20 years and included 174,000 patients with dementia. Of those, 35,000 received a new treatment with an antipsychotic drug.

Transcript in its entirety can be found by clicking here:
https://www.medscape.com/viewarticle/...