Impact of GLP-1 receptor agonists on stroke, subarachnoid hemorrhage, and intracerebral hemorrhage: a propensity-matched multi-institutional cohort study.

IF 3.6 2区医学 Q1 CLINICAL NEUROLOGY

Journal of neurosurgery Pub Date : 2025-10-03 DOI:10.3171/2025.5.JNS25786

Matias Costa, Sean O'Leary, Anthony M Price, Christopher C Young, Visish M Srinivasan, Peter Kan

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引用次数: 0

Abstract

Objective: The authors evaluated whether glucagon-like peptide-1 receptor agonists (GLP-1-RAs) improve outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH), spontaneous intracerebral hemorrhage (sICH), and acute ischemic stroke (AIS) and reduce the overall incidence of these events.

Methods: This retrospective study leveraged TriNetX data (2014-2024) to identify patients with aSAH, sICH, or AIS. Individuals receiving exenatide, lixisenatide, semaglutide, dulaglutide, liraglutide, or tirzepatide within 8 weeks of diagnosis were propensity matched to controls. Outcomes (e.g., mortality, rebleeding/recurrence, seizures, hydrocephalus) were assessed at 6 and 12 months; the incidence rates of stroke types were examined at 1 and 2 years.

Results: For aSAH patients, GLP-1-RA use at 6 months reduced rebleeding (OR 0.73, p = 0.003) and mortality (OR 0.41, p < 0.001) and at 1 year lowered cognitive deficits (OR 0.63, p = 0.034) and mortality (OR 0.39, p < 0.001). In sICH patients, GLP-1-RAs decreased hydrocephalus (OR 0.37, p = 0.005) and seizures (OR 0.56, p = 0.007) at 6 months, with persistent benefits at 1 year (hydrocephalus, OR 0.38, p = 0.007; seizures, OR 0.63, p = 0.018), alongside lower mortality (OR 0.45-0.40, both p < 0.001) and rebleeding (OR 0.70-0.69, both p < 0.001) rates. In AIS patients, mortality fell at 6 months (OR 0.27, p < 0.001) and 1 year (OR 0.44, p < 0.001), with reduced recurrence (OR 0.60, p < 0.001) and lower hydrocephalus (OR 0.32, p < 0.001) and seizure (OR 0.43, p < 0.001) rates at 6 months. At 1 year, GLP-1-RA users had lower incidence rates of SAH (OR 0.64, p = 0.001), ICH (OR 0.62, p < 0.001), and AIS (OR 0.82, p = 0.003), which were sustained at 2 years (ORs 0.77-0.87, all p < 0.05). Adverse events were similar.

Conclusions: GLP-1-RAs were associated with improved survival and fewer complications across stroke subtypes, plus reduced hemorrhagic and ischemic stroke incidence. Prospective trials are warranted to confirm these observations.

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GLP-1受体激动剂对中风、蛛网膜下腔出血和脑出血的影响：一项倾向匹配的多机构队列研究

目的：作者评估胰高血糖素样肽-1受体激动剂（GLP-1-RAs）是否能改善动脉瘤性蛛网膜下腔出血（aSAH）、自发性脑出血（sICH）和急性缺血性脑卒中（AIS）患者的预后，并降低这些事件的总体发生率。方法：这项回顾性研究利用TriNetX数据（2014-2024）来识别aSAH、sICH或AIS患者。诊断后8周内接受艾塞那肽、利昔那肽、西马鲁肽、杜拉鲁肽、利拉鲁肽或替西帕肽治疗的患者倾向与对照组相匹配。在6个月和12个月时评估结果（如死亡率、再出血/复发、癫痫发作、脑积水）；分别在1年和2年检查脑卒中类型的发病率。结果：对于aSAH患者，GLP-1-RA在6个月时降低了再出血（OR 0.73, p = 0.003）和死亡率（OR 0.41, p < 0.001），在1年内降低了认知缺陷（OR 0.63, p = 0.034）和死亡率（OR 0.39, p < 0.001）。在脑出血患者中，GLP-1-RAs在6个月时减少脑积水（OR 0.37, p = 0.005）和癫痫发作（OR 0.56, p = 0.007），并在1年后持续获益（脑积水，OR 0.38, p = 0.007；癫痫发作，OR 0.63, p = 0.018），同时降低死亡率（OR 0.45-0.40，均p < 0.001）和再出血（OR 0.70-0.69，均p < 0.001）。AIS患者的死亡率在6个月（OR 0.27, p < 0.001）和1年（OR 0.44, p < 0.001）时下降，6个月时复发率降低（OR 0.60, p < 0.001），脑积水（OR 0.32, p < 0.001）和癫痫发作（OR 0.43, p < 0.001）率降低。1年时，GLP-1-RA使用者的SAH （OR 0.64, p = 0.001）、ICH （OR 0.62, p < 0.001）和AIS （OR 0.82, p = 0.003）的发生率较低，且持续2年（OR 0.77-0.87，均p < 0.05）。不良事件相似。结论：GLP-1-RAs与卒中亚型生存率提高、并发症减少、出血性和缺血性卒中发生率降低相关。有必要进行前瞻性试验来证实这些观察结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of neurosurgery 医学-临床神经学

CiteScore

7.20

自引率

7.30%

发文量

1003

审稿时长

1 months

期刊介绍： The Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, and Neurosurgical Focus are devoted to the publication of original works relating primarily to neurosurgery, including studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology. The Editors and Editorial Boards encourage submission of clinical and laboratory studies. Other manuscripts accepted for review include technical notes on instruments or equipment that are innovative or useful to clinicians and researchers in the field of neuroscience; papers describing unusual cases; manuscripts on historical persons or events related to neurosurgery; and in Neurosurgical Focus, occasional reviews. Letters to the Editor commenting on articles recently published in the Journal of Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics are welcome.