Neuroprotective effect of Glibenclamide in stroke: a systematic review and meta-analysis of randomized controlled trials.

Background: Stroke is a leading cause of death and disability, with cerebral edema contributing to poor outcomes. Glibenclamide, a sulfonylurea with potential neuroprotective properties, has shown effect in reducing cerebral edema in preclinical studies. This meta-analysis aimed to evaluate its efficacy in functional outcomes, cerebral edema, and mortality in patients with acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and aneurysmal subarachnoid hemorrhage (aSH).

Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing Glibenclamide to standard care in the acute management of stroke was conducted. Outcomes included functional status (mRS 0-3 at 3 months), cerebral edema (midline shift at 72-96 h), mortality, and hypoglycemia events.

Results: Seven RCTs involving 1,225 patients met inclusion criteria. Glibenclamide did not improve functional status at 3 months in AIS and aSH but showed modest functional benefits in ICH (RR = 1.16; 95% CI: 1.04-1.28). No significant reduction in cerebral edema was observed in AIS (mean difference = 1.36 mm; 95% CI: -4.21 to 1.48). Mortality rates remained unchanged at discharge in aSH (RR = 0.78; 95% CI: 0.41-1.48) or at 3 months in AIS (RR = 0.97; 95% CI: 0.53-1.79). However, Glibenclamide increased hypoglycemia risk (RR = 3.57; 95% CI: 1.19-10.68).

Conclusion: This meta-analysis found no significant benefits in functional outcomes, cerebral edema, or mortality with Glibenclamide in acute stroke. Despite an increased hypoglycemia risk, encouraging results in individual trials suggest potential benefits in specific subgroups. Further research should focus on identifying these subpopulations to refine Glibenclamide's role as a neuroprotective therapy.