Metoclopramide of no help in improving pneumonia, functional outcomes in select stroke patients

For patients who have been placed on a nasogastric tube shortly after stroke onset, a 4-day treatment course of metoclopramide does not appear to have any effect on the incidence of pneumonia or functional outcomes, according to data from the PRECIOUS trial.

PRECIOUS* was an international, 3-by-2 partial-factorial, randomized controlled, open-label clinical trial that included 1,493 patients at least 66 years of age who had acute ischaemic stroke or intracerebral haemorrhage and a National Institutes of Health Stroke Scale score of ≥6.

The patients were randomly assigned to receive treatment with metoclopramide 10 mg, administered three times a day for 4 days or continued until discharge (if earlier), or standard care. Treatment was initiated within 24 hours of symptom onset.

The analysis included 1,376 patients, with 86 percent of them having ischaemic stroke and 14 percent having intracerebral haemorrhage. The first day after randomization, 329 (23.9 percent) patients were placed on a nasogastric tube, including 156 in the metoclopramide group and 173 in the standard care group.

Logistic regression analysis showed that compared with standard care, metoclopramide had no beneficial effect on the primary outcome of pneumonia incidence in the first week after stroke (41.0 percent vs 35.8 percent; adjusted odds ratio [aOR], 1.35, 95 percent confidence interval [CI], 0.79–2.30), as well as on the secondary outcome of the modified Rankin Scale score after 90 days (poor functional outcome: aOR, 1.07, 95 percent CI, 0.71–1.61).

*Prevention of Complications to Improve Outcome in Elderly Patients With Acute Stroke