MaravirocThe Canadian Maraviroc Randomized Controlled Trial To Augment Rehabilitation Outcomes After Stroke

Inclusion Criteria:

1. Primary ischemic anterior circulation stroke
2. Age ≥18 years
3. At least 5 days after stroke but within 8 weeks of stroke on the date of medication (maraviroc or placebo) start
4. Hemiparesis requiring inpatient rehabilitation
5. Assistance available for daily rehabilitation training practice and for transportation when needed
6. Adequate language skills to understand the Informed Consent and retain information during daily therapies
7. At least one of the following:

• some shoulder abduction with gravity eliminated and visible extension in two or more digits OR
• visible hip flexion or extension

Subgroup Stratification Criteria

1. For Upper Extremity Group:

• Minimum Ability: Medical Research Council (MRC) grade >1 for shoulder abduction AND MRC grade >1 for finger extensor on at least two digits
• Maximum Ability: Upper Extremity Fugl-Meyer Assessment Score >56

2. For Lower Extremity Group:

• Minimum Ability: requiring a 2-person assist
• Maximum Ability: walking speed <0.8m/s

Exclusion Criteria:

1. Pre-stroke modified Rankin score ≥ 2
2. Limited resources or illness that will not enable a return to living outside of a facility
3. History of dementia
4. History of hepatitis or elevated hepatic transaminases or bilirubin
5. History of renal insufficiency or creatinine clearance (eGFR) < 60mL / min / 1.73m2
6. Cancer or other chronic illness that makes 1-year survival unlikely or will detract from the ability to carry out exercise and skills practice
7. Existing pre-stroke serious disabling disease (e.g., Parkinson's disease, severe traumatic brain injury, amputation)
8. Seizure related to stroke
9. Acute or chronic epilepsy
10. Currently taking any of the following anticonvulsant medications:

• Carbamazepine
• Phenobarbital
• Phenytoin

11. Pregnant, breastfeeding, or positive test for pregnancy at baseline
12. Women of childbearing potential who are not using one highly effective form of contraception or two forms of effective contraception
13. Known HIV positivity
14. Currently taking any of the following antifungal and/or antibacterial medications:

• Ketoconazole
• Itraconazole
• Voriconazole
• Rifampin
• Clarithromycin
• Rifabutin + Protease Inhibitor

15. Currently taking St. John's Wort
16. Currently taking Paxlovid