New Research on Stroke Recovery, Crohn’s Care, Preterm Oxygen, and Allergy Prevention Leads Weekly Medical Review

This week’s medical review highlights four notable studies: an experimental stroke therapy, long-term outcomes from early aggressive Crohn’s disease treatment, oxygen targets for moderately preterm newborns, and a maternal diet trial aimed at preventing childhood food allergies.

Neuroprotective stroke therapy shows promise. A study in JAMA tested the intravenous drug loberamisal in patients with ischemic stroke who did not qualify for clot-dissolving drugs or mechanical thrombectomy. The compound is designed to protect and repair neurons by targeting two pathways involved in neuronal recovery. In a study of nearly 1,000 patients in China, those who received a 10-day course of IV loberamisal had better functional recovery at 90 days: 70% achieved a modified Rankin Scale score of 0 or 1, compared with 56% in the routine-care group. No serious safety concerns were reported. The authors suggest this type of neuroreparative therapy may eventually be used alongside reperfusion treatments, although further studies are needed.

Early top-down therapy appears durable in Crohn’s disease. The 5-year follow-up of the PROFILE trial, published in The Lancet, compared two treatment strategies in newly diagnosed adults with Crohn’s disease: top-down therapy with infliximab plus an immunomodulator from diagnosis, versus conventional step-up care that gradually intensified treatment. Among 386 patients treated at 40 UK hospitals, the top-down approach led to significantly fewer Crohn’s-related abdominal surgeries—six surgeries in six patients versus 28 surgeries in 26 patients in the step-up group. Time to surgery and time to first hospital admission were also longer in the top-down group. Importantly, rates of serious adverse events were similar between the groups, and the benefits appeared to apply regardless of whether patients were considered high- or low-risk.

Oxygen targets for preterm infants. A JAMA study from 26 Australian maternity hospitals examined whether giving 30% oxygen versus room air (21% oxygen) to moderately preterm infants born at 32 to 35 weeks’ gestation improved outcomes. All infants required respiratory support shortly after birth. Among more than 1,800 eligible newborns, about 73% needed ongoing respiratory support after leaving the delivery room. The investigators found no significant difference in the primary outcome between the 21% and 30% oxygen groups, and only two of 12 secondary outcomes showed modest benefit with higher oxygen. The primary endpoint was not met, suggesting routine use of 30% oxygen offers little advantage.

Maternal diet and egg or peanut allergy. A trial in the New England Journal of Medicine tested whether a high-intake maternal diet of eggs and peanuts during pregnancy and lactation could reduce allergy risk in high-risk infants. Pregnant women with at least two biologic family members with allergic disease were assigned to eat six eggs and 60 peanuts per week, or a standard diet with no more than three eggs and 30 peanuts weekly. The intervention began before 23 weeks’ gestation and continued through four months of breastfeeding. At one year, there was no significant difference in IgE-mediated egg or peanut allergy in the infants. Although one-third of participants did not complete the trial, the large sample size meant the study was powered to detect a meaningful difference had one existed. The researchers also noted a lower-than-expected overall allergy prevalence, which may have made it harder to identify a benefit.

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