Effect of DLBS1033 on Functional Outcomes for Patients with Acute Ischemic Stroke: A Randomized Controlled Trial

Abstract

Background. There are still some unmet needs for stroke management and safety. DLBS1033 is a protein fraction extracted from the earthworm Lumbricus rubellus that has shown fibrinolytic and fibrinogenolytic activities, reduces blood viscosity, and inhibits platelet aggregation that it can be considered an add-on therapy and potential medical breakthrough in acute ischemic stroke management. Objective. This study is aimed at measuring the benefit of DLBS1033 in acute ischemic stroke management. Methods. This was a randomized, open-label trial at a referral stroke center from November 2019 to December 2020. Subjects who met the inclusion criteria were randomly divided into a control group and an experimental group. The control group received standard therapy consisting of aspirin 100 mg once daily, atorvastatin 20 mg once daily, and vitamin B12 100 mg three times daily. The experimental group received standard therapy and DLBS1033 three times daily. The functional outcomes were measured using the National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), and modified Rankin Scale (mRS) at baseline, hospital discharge, and day 30. Results. Collected data from 180 subjects was analyzed. The NIHSS scores’ improvements were significantly greater in the experimental group compared to the control group at both hospital discharge ( $-5.57\pm 2.16$ vs. $-3.64\pm 2.65$ ; $p<0.001$ ) and day 30 ( $-6.62\pm 2.64$ vs. $-5.14\pm 2.41$ ; $p=0.001$ ). Compared with the control group, the improvements in the BI scores were significantly better in the experimental group, at both hospital discharge ( $10.69\pm 5.36$ vs. $6.64\pm 5.04$ ; $p<0.001$ ) and day 30 ( $10.9\pm 8.19$ vs. $8.56\pm 7.45$ ; $p=0.003$ ). The distribution of mRS scores was improved in both groups during 30 days of follow-up and was more favorable in the experimental group. In both groups, a favorable outcome ( $\text{mRS}<2$ ) was achieved better at day 30 (86.7% vs. 80%; $p=0.302$ ) than at baseline (0% vs. 6.7%; $p=0.028$ ) and at hospital discharge (58.9% vs. 43.3%; $p=0.085$ ). There was no clinically significant adverse event related to the study product. Conclusions. DLBS1033 in addition to the standard care was more effective in improving functional status compared to standard care alone in acute ischemic stroke patients with a similar safety profile.