Exenatide in acute ischemic stroke- a randomised controlled trial

This study will investigate the use of a drug called Exenatide in patients with acute ischaemic stroke. Exenatide is a drug currently approved for use in patients with type 2 diabetes to help control glucose levels. Research in animals and other laboratory studies suggests that exenatide may have a protective effect on brain cells by protecting cells that are at risk of dying in ischaemic stroke, as well as controlling glucose levels. Exenatide has also been shown to reduce the area of brain damaged by stroke. In this study we aim to have two groups of 25 patients – an exenatide treatment group and a control group. One group will receive an exenatide injection twice daily for 5 days after stroke, with the first dose given within 9 hours of the onset of stroke symptoms. These patients will also receive either metoclopramide 10 mg or ondansetron 4 mg twice daily intravenously to prevent nausea and vomiting for the first 3 days. The control group will have standard stroke care without exenatide treatment. Patients in both groups are also eligible to receive tPA therapy. Blood tests will be taken on days 0,1, 3, 5, 7 and 14 to assess glucose levels and other blood markers. Standard imaging for stroke patients will be done for participants in the study, including a CT scan before starting the trial and CT or MRI 3-5 days after the stroke. All the patients will also have continuous glucose monitoring done in the first 72 hours. This will be done by equipment called Guardian real-time CGM system (Medtronic), which has a sensor with a subcutaneous needle. We aim to look for any significant differences between the two groups for blood sugar control, clinical outcome and size of stroke on CT/MRI. We will also monitor participants closely for adverse events that may be linked to exenatide treatment.