Treatment with the glucagon-like peptide-1 receptor agonist (GLP-1RA) liraglutide in Chinese patients with type 2 diabetes (T2D) has the potential to reduce the risk of stroke recurrence and improve prognosis after a minor acute ischaemic stroke or a high-risk transient ischaemic attack (TIA), as suggested in the randomized, open-label LAMP study.

In the intention-to-treat analysis, the primary outcome of new stroke (ischaemic or haemorrhagic) within 90 days occurred in 7.9 percent of patients who received liraglutide in addition to usual care and in 13.8 percent of those who received usual care only (control), reported one of the study investigators Prof Hui-Li Zhu from The First Affiliated Hospital of Jinan University, Guangzhou, China. [ISC 2025, abstract LB44]

Compared with usual care only, the use of liraglutide was associated with a 44-percent reduction in the risk of stroke recurrence (hazard ratio [HR], 0.56, 95 percent confidence interval [CI], 0.34?0.91; p=0.02).

Zhu noted that the results for the secondary outcomes were also better in the liraglutide group than in the control group. Specifically, liraglutide-treated patients were more likely to achieve excellent functional outcome (mRS ≤1: 87.3 percent vs 77.8 percent; odds ratio [OR], 1.95, 95 percent CI, 1.28?3.00; p=0.002) and functional independence (mRS ≤2: 92.0 percent vs 86.7 percent; OR, 1.77, 95 percent CI, 1.06?3.02; p=0.032) at day 90. Fewer patients in the liraglutide than in the control group experienced new clinical vascular events (8.5 percent vs 15.7 percent; HR, 0.53, 95 percent CI, 0.33?0.84; p=0.006).

Finally, the use of liraglutide did not increase the risk of safety events. No significant differences between the liraglutide and the control groups were noted with regard to the incidence of symptomatic intracranial haemorrhage (0.3 percent vs 0.6 percent, respectively) and mortality (0.3 percent vs 1.3 percent, respectively).

“LAMP study is the first large-scale trial investigating GLP-1RAs in patients with ischaemic stroke, offering some valuable insights into their potential benefits for improving patient outcomes,” Zhu said.

The findings may have important implications, as “diabetes increases the risks of unfavourable prognosis and mortality in acute ischaemic stroke patients,” she added. [Eur Heart J 2018;39:2376-2386; Lancet Neurol 2012;11:261-271; N Engl J Med 2018;379:215-225; Stroke 2020;51:792-799]

Insufficient sample size

Zhu pointed out that the study was terminated early before reaching the planned enrolment of 1,708 participants due to a lower-than-expected enrolment rate and resulting financial constraints. This resulted in a post-hoc statistical power of 67 percent.

In total, 636 patients with T2D who were at least 50 years of age were included in LAMP. These patients were enrolled within 24 hours of onset of minor acute ischaemic stroke (NIHSS ≤3) or high-risk TIA (ABCD2 ≥4). There were 317 patients in the liraglutide group and 319 in the control group. For those in the liraglutide group, treatment was initiated within 1 hour of randomization. The GLP-1RA was given in subcutaneous injections daily at increasing doses: 0.6 mg/d from days 1?7, 1.2 mg/d from days 7?14, and then 1.8 mg/d through day 90. Patients in both groups received standard therapy according to the guidelines.

The median age of the cohort was 63.5 years, with 36.3 percent of patients being female. The baseline glycated haemoglobin (HbA1c) level was 8.2 percent. Most patients (93 percent) had large-artery atherosclerosis and small-vessel occlusion. Other baseline characteristics were similar between the treatment groups, including blood glucose levels, TOAST classification, and use of main secondary preventive medications, among others.

Given the insufficient sample size, Zhu advised careful interpretation of the data, including the pronounced effect of liraglutide seen in the subgroup of smokers and male patients. She called for additional research to confirm the potential benefits of liraglutide for T2D patients who have had a minor acute ischaemic stroke or high-risk TIA.