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Citicoline (cytidine-5'-diphosphocholine or CDP-choline) is an intermediate in the biosynthesis of phosphatidylcholine and is a neuronal membrane stabilizer. Citicoline showed immense promise in animal studies and in several phase II clinical trials. However, a phase III efficacy trial failed to show benefit. Despite this negative result, many believe that citicoline still holds promise as a stroke therapy. This is because in a post hoc analysis, citicoline was found to reduce ischemic lesion growth on diffusion-weighted MRI (DWI) when administered orally within 24 hours of ischemic stroke52, and a meta-analysis of four citicoline trials showed that a good outcome at 3 months was achieved in 25.2% of citico-line-treated patients versus 20.2% of controls (odds ratio [OR] 1.33; 95% confidence interval [CI] 1.10-1.62; p = 0.0034) .53 The International Citicoline Trial on Acute Stroke (ICTUS) is an ongoing study designed to examine the neuropro-tective effects of citicoline on clinical outcome after stroke when administered intravenously within 24 hours after stroke, followed by oral dosing.

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