by Isabella Colonna
For our April paper of the month we have chosen Lu Y, Guan L, Wu J, Yang Q, et al; EMPHASIS Investigators. Efficacy and safety of minocycline in patients with acute ischaemic stroke (EMPHASIS): a multicentre, double-blind, randomised controlled trial. Lancet. 2026 Feb 14;407(10529):679-688. doi: 10.1016/S0140-6736(25)01862-8. Epub 2026 Jan 30. PMID: 41628627.
Minocycline, a tetracycline antibiotic, has been shown to target post-ischaemic neuroinflammation, potentially improving outcomes after stroke. In this paper, the authors report the results of the EMPHASIS study, a prospective, randomised, double-blind, placebo-controlled trial conducted across 58 neurological centres in China, aimed at evaluating the efficacy and safety of minocycline in addition to routine treatment in patients with acute ischaemic stroke.
After screening for eligibility, 1,724 patients with acute ischaemic stroke (NIHSS 4–25) were randomly assigned to receive orally administered minocycline (n=862) or placebo (n=862). Treatment included a loading dose of 200mg administered within 30 minutes after randomisation and within 72 hours of symptom onset, followed by a maintenance dose of 100mg every 12 hours for the next four days.
At 90 days, a significantly higher proportion of patients in the minocycline group achieved a score of 0 (no symptoms) or 1 (no significant disability despite symptoms) on the modified Rankin Scale (mRS) compared with the placebo group (52.6% vs 47.4%; p = 0.006). Similarly, the overall distribution of mRS scores significantly favored the minocycline group. At six days, but not at 24 hours, significantly reduced NIHSS scores were observed in the minocycline group. No significant differences between the two groups were found in early neurological deterioration at 24 hours and six days, overall risk of stroke recurrence, or safety outcomes including serious adverse events.
In conclusion, this study shows that minocycline, administered within 72 hours of symptom onset in patients with acute ischaemic stroke, resulted in improved functional outcomes at 90 days compared to placebo, without safety concerns. These findings suggest that minocycline may be a safe and affordable treatment option for acute ischaemic stroke. However, further research is needed to confirm these results and determine whether its benefits extend to patients with both more severe and milder strokes.
