Glyburide in the Treatment of Cerebral Edema: A Systematic Review and Meta-analysis
Giovanna Salema Pascual1, Letícia Felício Saldanha2, Pedro Henrique Reginato3, Vinicius Furtado da Silva Castro4, Gabriel Mantovani5, Leonardo Zumerkorn Pipek4
1University of Bologna, 2Universidade Federal do Ceará, 3Universidade Federal do Paraná, 4Hospital das Clínicas da Faculdade de Medicina de São Paulo, 5Hospital de Clínicas de Porto Alegre
Objective:
To evaluate the efficacy and safety of glyburide in the treatment of patients with cerebral edema.
Background:
Cerebral edema is a common complication of numerous neurological conditions, associated with high mortality rate and with severe comorbidities that drastically reduce patients' ability and independence in daily activities.
Design/Methods:
We searched PubMed, Embase, Cochrane and Web of Science for studies comparing glyburide to either placebo or standard of care in treating cerebral edema. The protocol was registered on PROSPERO (CRD42024548600). The outcomes evaluated included good functional outcome (defined as modified Rankin Scale scores of 0-2), all-cause mortality, decompressive craniectomy rate, radiological worsening, and serious adverse effects (SAEs). Subgroup analyses examined the different etiologies for cerebral edema. Statistical analysis was performed using RStudio-4.4.0. Heterogeneity was assessed with I2 and random effect model.
Results:
We included 1501 patients from 12 studies, of which 10 were randomized control trials. Oral or IV glyburide was administered to 751 patients, with a mean age of 50.16 years, of whom 65.2% were male. Treatment with glyburide did not improve good functional outcome at 3 months (OR=1.29 [0.95-1.75]; p=0.12) or at 6 months (OR=1.40 [0.76-2.56]; p=0.28) compared to the control group. Additionally, there was no significant difference in decompressive craniectomy rate (OR=1.42 [0.58-3.48]; p=0.45), all-cause mortality (OR=0.66 [0.37-1.18]; p=0.1) and radiological worsening (SMD=-0.40 [-0.95-0.14]; p=0.15). However, glyburide increased SAEs (OR=1.35 [1.02-1.79]; p=0.03). Subgroup analyses showed no statistically significant differences in good functional outcome and all-cause mortality for any of the etiologies investigated: infarction, hemorrhage, and traumatic brain injury.
Conclusions:
Our findings suggest that glyburide does not substantially improve functional outcome and is not associated with reduction in decompressive craniectomy rate and all-cause mortality in the management of cerebral edema. Glyburide was, however, associated with a significant increase in SAEs.
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