Potential stroke-preventive effect of lomerizine hydrochloride in CADASIL patients

Abstract

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a genetic small vessel disease leading to recurrent strokes and cognitive decline. Stroke prevention is essential in CADASIL patients, since recurrent strokes determine the prognosis. However, there is no proven treatment for stroke prevention in CADASIL, although antiplatelet therapy is commonly used. Previous studies indicated reduced cerebral blood flow and impaired vasoreactivity in CADASIL patients, contributing to disease progression. Lomerizine hydrochloride is a calcium channel blocker approved in Japan for migraine prophylaxis. It has been reported to selectively inhibit cerebral artery contraction, increase cerebral blood flow, and exhibit neuroprotective effects. Therefore, lomerizine is a potential therapeutic agent for CADASIL patients. Preliminary data suggest the efficacy of lomerizine for preventing recurrent strokes in such patients. The LOMCAD trial, a multicenter, prospective, single-arm clinical trial comparing historical controls, designed to evaluate the efficacy of lomerizine to prevent recurrent ischemic events in CADASIL patients with recent histories of cerebral ischemic events, is currently underway. The results of this ongoing study are anticipated.