Efficacy and Safety of Glibenclamide in Post-Ischemic Stroke Cerebral Edema: A Systematic Review and Meta-Analysis

BackgroundThe potential of Glibenclamide to improve functional outcomes in patients with acute ischemic stroke remains controversial. This study aims to evaluate the benefit of Glibenclamide for patients with acute ischemic stroke and at risk of malignant brain edema. MethodsA comprehensive search was undertaken in January 2025 across several electronic databases, including PubMed, Scopus, Cochrane Library, Web of Science, and Embase. RCTs and observational studies were both considered eligible. Data extraction and analysis were done using Review Manager (RevMan) version 5.4. ResultsSix studies (four RCTs and two cohort studies) involving 1,244 patients were included; five were eligible for meta-analysis. Glibenclamide significantly reduced MMP-9 levels (MD = - 20.35; 95% CI: -23.65 to -17.04; P < 0.00001; I{superscript 2} = 0%) and midline shift (MD = -2.37 mm; 95% CI: -4.00 to -0.73; P = 0.005; I{superscript 2} = 83%). However, it did not significantly improve modified Rankin Scale scores or reduce the need for decompressive craniotomy. Glibenclamide was associated with a higher risk of hypoglycemia (RR = 3.30; 95% CI: 1.26-8.66; P = 0.02; I{superscript 2} = 0%) and serious adverse events (RR = 1.12; 95% CI: 1.01-1.24; P = 0.04; I{superscript 2} = 0%). No significant differences were observed in other adverse effects. ConclusionGlibenclamide may reduce inflammation and cerebral edema, but it increases the risk of hypoglycemia and serious adverse events. Given limitations in sample size and study variability, larger high-quality RCTs are needed to confirm efficacy and safety.