Glibenclamide For Patients With Acute Aneurysmal Subarachnoid Hemorrhage: A Systematic Review And Meta-Analysis
Julia Mello1, Barbara Antonia Talah2, Helen Beckert3, Giovanna Pontirolli4, Nuris Torres Argota5, Manuela Teles6, Hamilton Roberto Moreira de Oliveira Carriço7
1Pontifícia Universidade Católica de São Paulo, 2Universidade Católica do Paraná, 3Federal University of Paraná, 4Universidade Nove de Julho, 5Hospital of Mercy of Porto Alegre, 6Universidade do Estado do Amazonas, 7University Of Southern Santa Catarina
Objective:
We aimed to perform a systematic review and meta-analysis assessing the safety and efficacy outcomes in patients with acute aneurysmal subarachnoid hemorrhage comparing treatment with glibenclamide versus placebo.
Background:
Acute aneurysmal subarachnoid hemorrhage is a subtype of stroke frequently associated with disability. Glibenclamide is an antidiabetic that can cause hypoglycemia. Previous clinical studies and randomized controlled trials demonstrated that glibenclamide could have neuroprotective effects, including reduced cerebral edema and improved functional prognosis, as measured with the modified rankin scale (mRS), in patients with acute aneurysmal subarachnoid hemorrhage.
Design/Methods:
PubMed, Scopus, Cochrane and Web of Science databases were systematically searched for randomized controlled trials (RCTs) and observational studies comparing glibenclamide with placebo in patients with acute aneurysmal subarachnoid hemorrhage. Outcomes assessed were mean overall discharge mRS, mean discharge mRS between patients with favorable outcome, mean mRS after six months, hydrocephalus, hypoglycemia and delayed cerebral infarction (DCI). Statistical analysis was performed using RStudio. Heterogeneity was assessed with I² statistics.
Results:
Five studies met inclusion criteria, four RCTs and one observational study. A total of 419 patients were included, of whom 162 (38,67%) received treatment with glibenclamide and 257 (61,33%) received placebo. No statistical differences were found in mean overall discharge mRS, mean discharge mRS between patients with favorable outcome and hydrocephalus. Mean mRS after six months was significantly lower with treatment with glibenclamide (MD -0.88; 95% CI -1.32 to -0.44; P = 0.000086; I2 = 0%). DCI incidence was significantly lower with treatment with glibenclamide (OR 0.52; 95% CI 0.31 to 0.89; P = 0.017; I2 = 0%). Hypoglycemia was significantly higher with placebo (OR 3.80; 95% CI 1.01 to 14.30; P = 0.0479; I2 = 0%).
Conclusions:
Our findings suggest that glibenclamide is effective for neuroprotection in the treatment of acute aneurysmal subarachnoid hemorrhage.
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