Glibenclamide in Acute aSAH
Trial question
What is the role of glyburide in patients with acute aneurysmal subarachnoid hemorrhage?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
52.0% female
48.0% male
N = 111
111 patients (58 female, 53 male)
Inclusion criteria: patients with aneurysmal subarachnoid hemorrhage within 48 hours of onset
Key exclusion criteria: previous diagnosis of aneurysm; history of stroke, epilepsy, and neurodegenerative diseases
Interventions
N=60 glyburide (at a dose of 1.25 mg TID plus standard care for 7 days)
N=60 standard of care (standard care for aneurysmal subarachnoid hemorrhage without glyburide)
Primary outcome
Median levels of serum neuron-specific enolase at day 7
7.24
8.15
8.2 ng/mL
6.1 ng/mL
4.1 ng/mL
2.0 ng/mL
0.0 ng/mL
Glyburide
Standard of
care
No significant
difference ↔
No significant difference in median levels of serum NSE at day 7 (7.24 ng/mL vs. 8.15 ng/mL; AD -0.91 ng/mL, 95% CI -2.99 to 1.17)
Secondary outcomes
No significant difference in median levels of soluble protein 100B (0.08 mcg/mL vs. 0.09 mcg/mL; AD -0.01 mcg/mL, 95% CI -0.04 to 0.02)
No significant difference in midline shift (25% vs. 22%; AD 3%, 95% CI -0.01 to 6.01)
No significant difference in mRS score of 0-2 at day 90 (53% vs. 56%; ARD -3, 95% CI -16.71 to 10.71)
Safety outcomes
No significant difference in hypoglycemia and adverse events.
Conclusion
In patients with aneurysmal subarachnoid hemorrhage within 48 hours of onset, glyburide was not superior to standard of care with respect to median levels of serum NSE at day 7.
Reference
Qing Lin, Dawei Zhou, Jiawei Ma et al. Efficacy and Safety of Early Treatment with Glibenclamide in Patients with Aneurysmal Subarachnoid Hemorrhage: A Randomized Controlled Trial. Neurocrit Care. 2024 Aug 8. Online ahead of print.
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