Glibenclamide in Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Aneurysmal subarachnoid hemorrhage (aSAH) is a critical neurological condition with high morbidity and mortality. This study aims to evaluate the effectiveness of glibenclamide through a systematic review and meta-analysis of randomized controlled trials (RCTs). We performed a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, focusing on RCTs assessing glibenclamide's safety and efficacy in aSAH patients. A comprehensive search of multiple databases was conducted, with studies published until January 2025. Statistical analysis was conducted using RevMan software (The Cochrane Collaboration, London, UK) to determine the effect of glibenclamide on clinical outcomes. A total of four RCTs with 290 patients were included. No significant differences were observed between the glibenclamide and control groups in delayed cerebral ischemia (DCI) (risk ratio (RR): 0.58, 95% confidence interval (CI): 0.31 to 1.10, P = 0.09, I² = 0%), hydrocephalus (RR: 1.65, 95% CI: 0.97 to 2.71, P = 0.06, I² = 0%), death (RR: 0.88, 95% CI: 0.50 to 1.56, P = 0.66, I² = 0%), or hypoglycemia (RR: 3.53, 95% CI: 1.00 to 12.54, P = 0.05, I² = 0%). Additionally, no significant differences were found in modified Rankin Scale (mRS) scores at six months (mean difference (MD): -0.45, 95% CI: -1.11 to 0.20, P = 0.18, I² = 0%) or at three months (MD: 0.06, 95% CI: -0.60 to 0.72, P = 0.86, I² = 0%). This meta-analysis found no significant advantage of glibenclamide over the control group in improving outcomes for aSAH patients. Despite the generally low risk of bias in the studies, potential publication bias should be considered when interpreting these findings.