#3-55E. Targeting Neuroinflammation: Minocycline for Acute Ischaemic Stroke (Lancet, 2026)

Targeting post-stroke neuroinflammation has long been a therapeutic goal, yet successful clinical interventions have remained elusive. In this episode, we analyze the EMPHASIS trial, a landmark study evaluating the efficacy of minocycline in patients with acute ischaemic stroke. This large-scale, multicenter, double-blind, randomized controlled trial involved 1,724 patients in China who received either oral minocycline or placebo within 72 hours of symptom onset. The study demonstrated that minocycline significantly increased the likelihood of achieving excellent functional outcomes (mRS 0–1) at 90 days compared to placebo, with an adjusted risk ratio of 1.11, and showed no significant increase in safety risks such as intracranial hemorrhage. While these findings suggest a breakthrough for a low-cost, accessible neuroprotective agent, listeners must critically consider that the trial was conducted exclusively in China, potentially limiting generalizability to other ethnic populations, and excluded patients with very severe or minor strokes. For clinicians, this study highlights a potential new standard for adjunctive therapy that extends the therapeutic window, offering a practical tool to reduce long-term disability in stroke survivors.

Citation: Lu Y, Guan L, Wu J, et al. Efficacy and safety of minocycline in patients with acute ischaemic stroke (EMPHASIS): a multicentre, double-blind, randomised controlled trial. Lancet. 2026. DOI: 10.1016/S0140-6736(25)01862-8

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