Assessing Glibenclamide's efficacy on functional recovery in aneurysmal subarachnoid hemorrhage: A meta-analysis of randomized controlled trials.

Introduction: Glibenclamide, a sulfonylurea receptor 1 (SUR1) inhibitor initially developed for diabetes, has shown potential in reducing cerebral edema and neuroinflammation. This study evaluates its efficacy in improving functional outcomes and reducing complications in aSAH.

Methods: Databases including PubMed, EMBASE, and Web of Science were searched for RCTs assessing Glibenclamide's effects in aSAH. Outcomes included modified Rankin Scale (mRS), mortality, rebleeding risk, hydrocephalus incidence, and hospital stay duration. Risk Ratio (RR) and Mean Differences (MD) were calculated using random- or fixed-effects models based on heterogeneity (I² statistic).

Results: Four RCTs (290 participants) met inclusion criteria. No significant differences were found in mRS scores at 90 days (MD: 0.06, 95 % CI: -0.59-0.71, p = 0.86) or 180 days (MD: -0.43, 95 % CI: -1.09-0.23, p = 0.20). Similarly, mortality (RR: 0.87, 95 % CI: 0.49-1.54, p = 0.665), rebleeding risk (RR: 0.78, 95 % CI: 0.23-2.60, p = 0.639), hydrocephalus incidence (RR: 1.64, 95 % CI: 0.96-2.79, p = 0.064), and hospital stay (MD: 0.09 days, 95 % CI: -2.15-2.32, p = 0.94) showed no significant differences. The meta-regression analysis showed that Glibenclamide dosage (p = 0.0007) and modified Fisher Scale (p = 0.0312) were significantly associated with mRS outcomes, while age (p = 0.1506), WFNS grade (p = 0.1956), and Hunt-Hess Scale (p = 0.1464) had no significant impact.

Conclusion: Current evidence indicates that Glibenclamide does not significantly improve outcomes or reduce complications in aSAH. While promising for cerebral edema, larger multicenter RCTs with standardized protocols and extended follow-ups are needed to clarify its role.