Effect of Calcitonin Gene-Related Peptide on Outcome of Ischaemic Deficits After Subarachnoid Haemorrhage European CGRP in Subarachnoid Haemorrhage Study Group

Summary

A randomised multicentre single blind comparison of calcitonin gene-related peptide (CGRP) against standard best management has been conducted in patients suffering ischaemic deficits after surgery for a ruptured intracranial aneurysm. Patients aged 18 to 70 years who developed a focal neurological deficit or had a reduction of two or more points on the Glasgow coma scale (GCS) after surgery, were entered after a CT scan had excluded non-ischaemic causes for their neurological deficits. Informed consent was obtained and pregnancy, uncorrected hypovolaemia, and serious concomitant illness were exclusion criteria. After randomisation, 62 patients were allocated to receive an infusion of 0.6 ug/min of CGRP for a minimum of four hours up to a maximum of 10 days, and 55 patients received standard best management. GCS and haemodynamic parameters were assessed during the patients’ hospital stay, and all patients were followed up at three months by an independent investigator, who was blind to their treatment. Outcome was measured on the Glasgow outcome scale, and 16 neurosurgical units contributed patients, 12 centres in the UK and Ireland, and four in the rest of Europe. At three month follow up 66% of those treated with CGRP and 60% of those receiving best management had a good outcome, with the relative risk of a poor outcome in CGRP treated patients being 0.88 (95% confidence interval 0.60 to 1.28). Hypotension was a common side effect of the CGRP infusion. Although a significant beneficial effect has not been demonstrated by the trial, a clinically useful benefit has not been excluded.

A.M. Aziz, Cork; I.C. Bailey, Royal Victoria Hospital, Belfast; M. Barnes, Newcastle General Hospital; J.R. Bartlett, Brook General Hospital, London; B.A. Bell, Atkinson Morley’s Hospital, London; I. Bone, Southern General Hospital, Glasgow; G. Braadvedt, Bristol Royal Infirmary; T.F. Buckley, Cork; L. Calandre, Instituto Nacional de la Salud, Madrid; J.P. Castel, Groupe Hospitalier Pellegrin, Bordeaux; U. Choksey, Newcastle General Hospital; J.A. Cozens, Newcastle General Hospital; O.P. Dahl, Regionsykehuset I Trondheim; P.S. Dias, Royal Hallamshire Hospital, Sheffield; D. Dorrance, Brook General Hospital, London; P. Foy, Walton Hospital, Liverpool; R.G. Galvin, Cork; D. Grosset, Western Infirmary, Glasgow; R.W. Gullan, Brook General Hospital, London; D.T. Hope, Queen’s Medical Centre, Nottingham; S. Howell, Royal Hallamshire Hospital, Sheffield; P.R.D. Humphrey, Walton Hospital, Liverpool; J. Hutchison, Beaumont Hospital, Dublin; J. Jakubowski, Royal Hallamshire Hospital, Sheffield; D. Jefferson, Queen’s Medical Centre, Nottingham; F.G. Johnston, Atkinson Morley’s Hospital, London; R. Juul, Regionsykehuset I Trondheim; Y. Kereval, Paris; A. Keshtgar, Cork; J. Lagarrigue, CHR Rangueil, Toulouse; V. Larrue, CHR Rangueil, Toulouse; R.D. Lobato, Instituto Nacional de la Salud, Madrid; J.A. Lyttle, Royal Victoria] Hospital, Belfast; J.C. Marks, Cork; B. Martin, Southampton General Hospital; J. Martin, Southampton General Hospital; B. Matthew, Royal Victoria Hospital, Belfast; J. McMahon, Newcastle General Hospital; A.D. Mendelow, Newcastle General Hospital; J.D. Miller, Western General Hospital, Edinburgh; D. Mohan, Derriford Hospital, Plymouth; K. Morris, Walton Hospital, Liverpool; G.D. Murray, Glasgow Royal Infirmary; R.J. Nelson, Frenchay Hospital, Bristol; S.A. O’Laoire, Beaumont Hospital, Dublin; J.-M. Orgogozo, Groupe Hospitalier Pellegrin, Bordeaux; J.D. Pickard, Southampton General Hospital; I.J.A. Robertson, Brook General Hospital, London; M.D.M. Shaw, Walton Hospital, Liverpool; J. Singh, Beaumont Hospital, Dublin; J. Stanley, Southampton General Hospital; G. Stranjalis, Frenchay Hospital, Bristol; S.R. Stapleton, Atkinson Morley’s Hospital, London; W.A.S. Taylor, Atkinson Morley’s Hospital, London; G.M. Teasdale, Southern General Hospital, Glasgow; B. White, Queen’s Medical Centre, Nottingham.