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Huang K, Zhao X, Zhao Y, Yang G, Zhou S, Yang Z, Huang W, Weng G, Chen P, Duan C, Lin Z, Wang S, Liu X, Huang Y, Zhang J, Zhang X, Li H, Ye S, Gu Y, Zhu M, Chen W, Quan W, Liu N, Chen Q, Chang Y, He J, Ji Z, Wu Y, Pan S. Safety and efficacy of glibenclamide combined with rtPA in acute cerebral ischemia with occlusion/stenosis of anterior circulation (SE-GRACE): a randomized, double-blind, placebo-controlled trial. EClinicalMedicine 2023; 65:102305. [PMID: 37965431 PMCID: PMC10641480 DOI: 10.1016/j.eclinm.2023.102305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 11/16/2023] Open
Abstract
Background Glibenclamide alleviates brain edema and improves neurological outcomes in experimental models of stroke. We aimed to assess whether glibenclamide improves functional outcomes in patients with acute ischemic stroke treated with recombinant tissue plasminogen activator (rtPA). Methods In this randomized, double-blind, placebo-controlled trial, patients with acute ischemic stroke were recruited to eight academic hospitals in China. Patients were eligible if they were aged 18-74 years, presented with a symptomatic anterior circulation occlusion with a deficit on the NIHSS of 4-25, and had been treated with rtPA within 4.5 h of symptom onset. We used web-based randomization (1:1) to allocate eligible participants to the glibenclamide or placebo group, stratified according to endovascular treatment and baseline stroke severity. Glibenclamide or placebo was taken orally or via tube feeding at a loading dose of 1.25 mg within 10 h after symptom onset, followed by 0.625 mg every 8 h for 5 days. The primary outcome was the proportion of patients with good outcomes (modified Rankin Scale of 0-2) at 90 days, assessed in all randomly assigned patients who had been correctly diagnosed and had begun study medication. The study is registered with ClinicalTrials.gov, NCT03284463, and is closed to new participants. Findings Between January 1, 2018, and May 28, 2022, 305 patients were randomly assigned, of whom 272 (142 received glibenclamide and 130 received placebo) were included in the primary efficacy analysis. 103 (73%) patients in the glibenclamide group and 94 (72%) in the placebo group had a good outcome (adjusted risk difference 0.002, 95% CI -0.098 to 0.103; p = 0.96). 12 (8%) patients allocated to glibenclamide and seven (5%) patients allocated to placebo died from any cause at 90 days (p = 0.35). The number and type of adverse events were similar between the two groups. There were no drug-related adverse events and no drug-related deaths. Interpretation The addition of glibenclamide to thrombolytic therapy did not increase the proportion of patients who achieved good outcomes after stroke compared with placebo, but it did not lead to any safety concerns. Funding Southern Medical University and Nanfang Hospital.
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Affiliation(s)
- Kaibin Huang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaolin Zhao
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yunxiao Zhao
- Department of Neurology, Huadu District People's Hospital of Guangzhou, Guangzhou, China
| | - Guoshuai Yang
- Department of Neurology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China
| | - Saijun Zhou
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhi Yang
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Wenguo Huang
- Department of Neurology, Guangdong Maoming Traditional Chinese Medicine Hospital, Maoming, China
| | - Guohu Weng
- Department of Neurology, Hainan Hospital of Traditional Chinese Medicine, Haikou, China
| | - Pingyan Chen
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Chongyang Duan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Zhenzhou Lin
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shengnan Wang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiangmin Liu
- Department of Neurology, Huadu District People's Hospital of Guangzhou, Guangzhou, China
| | - Yunqiang Huang
- Department of Neurology, Heyuan People's Hospital, Heyuan, China
| | - Jiangshan Zhang
- Department of Neurology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China
| | - Xu Zhang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hao Li
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Songsheng Ye
- Department of Neurology, Guangdong Maoming Traditional Chinese Medicine Hospital, Maoming, China
| | - Yong Gu
- Department of Neurology, Hainan Hospital of Traditional Chinese Medicine, Haikou, China
| | - Minzhen Zhu
- Department of Neurology, Heyuan People's Hospital, Heyuan, China
| | - Weiying Chen
- Department of Neurology, Huadu District People's Hospital of Guangzhou, Guangzhou, China
| | - Weiwei Quan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Na Liu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Quanfeng Chen
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yuan Chang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jinzhao He
- Department of Neurology, Heyuan People's Hospital, Heyuan, China
| | - Zhong Ji
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yongming Wu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Suyue Pan
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - SE-GRACE Collaborators
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Neurology, Huadu District People's Hospital of Guangzhou, Guangzhou, China
- Department of Neurology, Heyuan People's Hospital, Heyuan, China
- Department of Neurology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Neurology, Hainan Hospital of Traditional Chinese Medicine, Haikou, China
- Department of Neurology, Guangdong Maoming Traditional Chinese Medicine Hospital, Maoming, China
- Department of Neurology, Maoming People's Hospital, Maoming, China
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
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