Aspirin, cilostazol exert similar effects on white matter changes in cerebral small vessel disease

The progression of white matter changes in cerebral small vessel disease does not seem to be different between aspirin- and cilostazol-treated patients, a study has found.

The study included 256 patients with moderate or severe white matter changes and at least one lacunar infarction detected on brain magnetic resonance imaging. They were randomized to receive either cilostazol 200-mg slow-release capsule (n=127) or aspirin 100 mg (n=129) once daily for 2 years.

The primary efficacy endpoint was the change in white matter volume on magnetic resonance images from baseline to 2 years. Secondary outcomes included changes in the number of lacunes or cerebral microbleeds, fractional anisotropy, mean diffusivity on diffusion tensor images, and brain atrophy.

The changes in white matter volume were also evaluated in relation to all ischaemic strokes, all ischaemic vascular events, and changes in cognition, motor function, mood, urinary symptoms, and disability.

Over 2 years, the percentage of changes in white matter volume relative to total white matter volume and to intracranial volume at baseline increased in both aspirin and cilostazol groups. However, the observed changes were not significantly different between the two groups.

The peak height of the mean diffusivity histogram in normal-appearing white matter was much lower in the aspirin group than in the cilostazol group.

Finally, cilostazol treatment led to significant reduction in the risk of ischaemic vascular event compared with aspirin (0.5 vs 4.5 cases per 100 person-years; hazard ratio, 0.11, 95 percent confidence interval, 0.02–0.89).