Jennifer Dearborn, MD

Sheth KN, Kimberly WT, Elm JJ, Kent TA, Mandava P, Yoo AJ, et al. Pilot Study of Intravenous Glyburide in Patients With a Large Ischemic Stroke. Stroke. 2013

Sheth et al. recently published the pilot trial of glyburide for acute ischemic stroke (AIS). This study is a safety and feasibility study performed on ten patients at two academic centers. The rationale behind glyburide for AIS is that the sulfonylurea receptor 1 (SUR1) and the transient receptor potential melastatin 4 are upregulated in acute ischemia, leading to osmotic swelling from the uptake of sodium and water. Glyburide acts on the SUR1 receptor and is an inhibitor, therefore acute intravenous administration may reduce edema acutely. In this phase IIa trial, the rates of recruitment and the ability to manage blood glucose levels with administration of IV glyburide were assessed. Subjects to 18 to 80 years old with a DWI infarct volume 82 to 210 cm3 who were less than ten hours from stroke onset were included. 

It was exciting that there were no instances of hypoglycemia reported and that recruitment rates were higher than expected. Glyburide seems feasible as an acute treatment of stroke and future studies will need to assess the efficacy of the treatment. Based on historical controls, the subjects had lower increases in hemispheric volumes after stroke. The authors correctly point out that there is an urgent need to bring this therapy to larger scale trials to see if it can improve post stroke outcomes and functional recovery.