Abstract Details

Title Glyburide in the Treatment of Cerebral Edema: A Systematic Review and Meta-analysis

Topic Neuro Trauma and Critical Care

Presentation(s) P12 - Poster Session 12 (11:45 AM-12:45 PM)

Poster/Presentation
Number 7-004

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 I²and 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.

Authors/Disclosures
Giovanna Salema Pascual PRESENTER	Miss Salema Pascual has nothing to disclose.
Letícia F. Saldanha, MS	Miss Saldanha has nothing to disclose.
Pedro Henrique Reginato	Mr. Reginato has nothing to disclose.
Vinicius Castro (Condomínio Silvério Gusmão)	Mr. Castro has nothing to disclose.
Gabriel P. Mantovani	Mr. Mantovani has nothing to disclose.
Leonardo Pipek, MD (University of São Paulo)	Dr. Pipek has nothing to disclose.

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