Maraviroc for Stroke Recovery (MASTER): protocol for a phase 2 double-blind placebo-controlled randomised clinical trial.

introductionDespite advances in acute treatment, stroke remains the first cause of acquired disability. Today, there is no effective pharmacological therapy to improve recovery beyond the acute phase. Preclinical studies suggest that inhibition of the C-C chemokine Receptor 5 (CCR5) may promote recovery by enhancing plasticity in the peri-infarct cortex. However, the role of CCR5 to improve outcome after ischaemic stroke in humans is unknown. METHODS AND ANALYSIS: MAraviroc for STrokE Recovery is a phase II, single-centre, randomised, double-blind, placebo-controlled trial. The aim is to assess the efficacy and safety of the CCR5 antagonist Maraviroc for improving motor recovery of the upper limb after ischaemic stroke. 80 ischaemic stroke patients with moderate but incomplete upper extremity motor impairment will be enrolled within 7 days of onset. Participants will be randomised (1:1) to receive either oral maraviroc (300 mg two times per day) or placebo for 90 days in addition to standard rehabilitation therapy. The primary outcome is upper limb motor function assessed using the Fugl-Meyer Assessment for the Upper Extremity at day 90. Secondary outcomes include motor learning skills and plasticity in the peri-infarct region assessed using MRI connectivity and spectroscopy at 90 days. ETHICS AND DISSEMINATION: The study protocol has been reviewed and approved by the Geneva Competent Ethics Committee (Commission Cantonale d'Éthique, CEC; Reference Number: CCER 2024-02359) and Swissmedic (Swiss Agency for Therapeutic Products). Written informed consent will be obtained from all participants. Study results will be disseminated through peer-reviewed publications and scientific conferences. TRIAL REGISTRATION NUMBER: 2024-02359; NCT07080567.