- Design
- Systematic review and meta-analysis of RCTs with trial sequential analysis
- Population
- 9 trials, 2,186 patients with acute ischaemic or haemorrhagic stroke
- Primary outcome
- NIHSS and functional outcome at 3 months
- Effect
- Ischaemic stroke: NIHSS −2.43 (−4.42 to −0.44); mRS 0–2 RR 1.40 (1.05–1.86)
Minocycline, an old and cheap tetracycline, has been tested as a neuroprotectant for its anti-inflammatory effects. This meta-analysis pooled nine randomised trials with 2,186 patients with ischaemic or haemorrhagic stroke.
In ischaemic stroke, minocycline was associated with lower NIHSS at three months (mean difference −2.43, 95% CI −4.42 to −0.44) and more patients functionally independent (mRS 0–2: RR 1.40, 1.05–1.86). It did not improve the stricter mRS 0–1 outcome, and showed no benefit in intracerebral haemorrhage. Mortality, recurrent events and haemorrhagic transformation did not differ.
The authors rate the evidence as low certainty with substantial heterogeneity, and trial sequential analysis showed the evidence is not yet enough for a firm conclusion. Several of the trials were small and single-centre, some from South Asia, where minocycline is widely available and inexpensive — which is exactly why a definitive trial would matter.
- Minocycline is not a recommended treatment for acute stroke in any current major guideline.
- Reperfusion therapy and organised stroke-unit care remain the treatments with proven benefit.
- Small positive trials of cheap neuroprotectants have often not been confirmed in larger ones.
- Watch for adequately powered trials before considering minocycline outside a study.
Why it matters
A cheap, available drug with a recovery signal deserves a definitive trial, but has not had one.
Don't overread it
Low-certainty pooled data; this does not show minocycline improves recovery after stroke.
The statistics, in plain English
Trial sequential analysis asks whether enough patients have been studied to trust a result; here it says no. A significant pooled result from several small, varied trials can shrink or disappear when a large trial is done.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for neurology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free