Minocycline in acute stroke
Muhammad Shahzaib, Muhammad Roshaan, Gaaitri Lohano, Marium Fawad, Haram Nabeel, Muhammad Noraiz Abbas Khan, Muhammad Rehan Zahid, Muhammad Nabeel, Nimra Afzal, Muhammad Shahryar, Eman Shahzad, Prince Kusimw’iragiBackground:
Minocycline has emerged as a potential adjunctive neuroprotective therapy in acute stroke owing to its anti-inflammatory, antiapoptotic, and blood–brain barrier-stabilizing effects. We aimed to evaluate the efficacy and selected safety-related outcomes of minocycline in acute stroke, including ischemic and hemorrhagic subtypes.
Methods:
This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Major databases were searched through March 20, 2026 for randomized controlled trials comparing minocycline with control or standard care in acute stroke. Risk ratios (RRs) and mean differences were pooled with 95% confidence intervals (CIs). Risk of bias was assessed using ROB 2, certainty of evidence using Grading of Recommendations Assessment, Development, and Evaluation, and robustness using trial sequential analysis.
Results:
Nine trials including 2186 participants were analyzed. Minocycline significantly reduced 3-month National Institutes of Health Stroke Scale scores in acute ischemic stroke (mean difference −2.43, 95% CI −4.42–−0.44;
Conclusion:
Minocycline may improve neurological recovery in acute ischemic stroke; however, these findings remain exploratory because of substantial heterogeneity, low-certainty evidence, and inconclusive trial sequential analysis. Larger standardized trials are required.