by Isabella Colonna and Raphael Wurm
Each month the eanNews editorial team reviews the scientific press for recently published papers of outstanding interest to neurologists. Below we present our selection for June 2026.
For our Paper of the Month, go here: Research Paper of the Month: Research Paper of the Month: Three Low-Dose Antihypertensive Agents in a Single Pill after Intracerebral Hemorrhage – eanNews
Combination Therapy of Nicotinamide Riboside and Exercise Enhances Cardiopulmonary Fitness in Friedreich’s Ataxia
This phase 2, single-site trial evaluated the safety and efficacy of individualised exercise and supplementation with the NAD+ precursor nicotinamide riboside in 66 children and adults with Friedreich’s ataxia. Over a 12-week period, participants were allocated to one of four groups: placebo only (n=17), nicotinamide riboside only (n=17), exercise only (n=16), or a combination of nicotinamide riboside and exercise (n=16). The primary outcome measured the change in peak VO2 (L/min) from baseline.
The least mean squares for change in peak VO2 were -0.05 (95% CI -0.16 to 0.06) for the control group, 0.06 (-0.05 to 0.17) for nicotinamide riboside only, 0.11 (0.00 to 0.22) for exercise only, and 0.16 (0.05 to 0.27) for the combination therapy group. The combination therapy thus led to a significant increase in cardiopulmonary fitness (0.21, 95% CI 0.05 to 0.36; p = 0.03) compared to control; however, this was not significant when compared to exercise alone. Adverse events were mild to moderate, with at least one moderate event reported by 41% of the control group, 35% of the nicotinamide riboside group, 19% of the exercise group, and 25% of the combination group. This trial showed that the combination of a NAD+ precursor and exercise is safe in Friedreich’s and might lead to more pronounced training effects than exercise alone.
Asundexian Safely Reduces Recurrent Ischemic Stroke Risk in Noncardioembolic Stroke or High-Risk TIA
This phase 3, double-blind, randomised controlled trial (OCEANIC-STROKE) evaluated the efficacy and safety of adding asundexian, an activated factor XI inhibitor, to standard antiplatelet therapy for secondary stroke prevention. A total of 12,327 patients presenting within 72 hours of a non-cardioembolic ischaemic stroke or high-risk transient ischaemic attack with evidence of atherosclerosis or non-lacunar infarcts were randomized to receive either 50 mg asundexian once daily or a matching placebo.
The primary efficacy outcome of ischaemic stroke occurred significantly less frequently in the asundexian group compared to the placebo group: in 6.2% versus 8.4% of patients (cause-specific hazard ratio, 0.74; 95% confidence interval [CI], 0.65 to 0.84; p-value < 0.001). The key secondary composite outcome of death from cardiovascular causes, myocardial infarction, or stroke was also lower with asundexian. The primary safety outcome of major bleeding was similar between the groups, occurring in 1.9% of the asundexian group and 1.7% of the placebo group (cause-specific hazard ratio, 1.10; 95% CI, 0.85 to 1.44). Overall adverse event rates (69.3% vs. 70.1%) and serious adverse events (19.2% vs. 19.5%) were comparable between treatments. This important study expands our toolkit for prevention in non-cardioembolic stroke, perhaps paving the way for factor XI inhibition with more trials and substances on the horizon.
Read the paper here: Asundexian for Secondary Stroke Prevention | New England Journal of Medicine
Endovascular Therapy for Medium and Distal Vessel Occlusion Stroke: Results from the DISTAL Trial
The role of endovascular therapy in patients with acute ischaemic stroke caused by medium or distal vessel occlusion is still unclear. This paper reports the results of the DISTAL trial, a randomised, international, assessor-blinded study designed to evaluate the efficacy of endovascular treatment in patients presenting within 24 hours from the last known well.
Participants were randomly assigned to receive either endovascular treatment plus best medical care (n = 271) or best medical care alone (n = 272). At 12 months, no significant differences were observed between the two groups in the distribution of modified Rankin Scale (mRS) scores or in patient-reported outcomes.
These findings suggest that, in patients with acute ischaemic stroke due to medium or distal vessel occlusion, endovascular treatment in addition to best medical care is not superior to best medical care alone.
Read the paper here: Endovascular treatment for medium or distal vessel occlusion stroke (DISTAL): 12-month outcomes of a multicentre, open-label, randomised trial – The Lancet Neurology
