Evaluate the Use of Glibenclamide on Acute aSAH

The Safety and Effectiveness of Glibenclamide in the Treatment of Aneurysm Subarachnoid Hemorrhage（aSAH）: a Randomized Controlled Clinical Study

A randomized, open-labeled, blank-controlled and prospective trial meant to evaluate the use of glibenclamide on acute aneurysmatic subarachnoid hemorrhage. Patients will allocated randomly in two groups, one for 3.75 mg daily intake of glibenclamide for 7 days and another as a blank contrast. General clinical data and late cognitive status will be accessed in both groups.

Study Overview

• Status: Recruiting
• Conditions: Subarachnoid Hemorrhage
• Intervention / Treatment: Drug: glibenclamide

Detailed Description

The study is a open-labeled, blank-controlled, prospective and randomized clinical trial, conducted at Tiantan Hospital and Tongren Hospital, affiliated with the Capital Medical University. Patients will be recruited from intensive care units. Appropriate ethics and regulatory approvals will be sought for all subjects, according to the International Conference on Harmonization guidelines for good clinical practice (ICH GCP). Investigators will obtain informed written consent from all patients or their legal representative. Recruitment will take place between 2021 and 2022.

Patients will be randomly assigned (1:1) to receive either glibenclamide 3.75mg or blank contrast. A computer-generated randomization code will be used to randomize patients. Patients will start treatment as soon as possible within 48 h of the stroke, with a daily dose till the 7 days after the recruitment. Trial medication consisted of one and a half pieces of tablet a day, given orally or via a nasogastric tube. Aneurysm treatment, either by microsurgery or embolization, will be performed as soon as possible, according with the standard of care for the recruiting center. Nimodipine 60mg, every six hours, will be started on admission and continued till two weeks later, in all patients as standard of care.

Patient's demographics, medical history and relevant investigation results will be collected. The severity of the hemorrhage will be clinically assessed by World Federation of Neurosurgical Societies grading scale and radiologically using the modified Fischer scale. At 90 days of follow up patients will be interviewed with modified Rankin scale (mRS) questionnaire (a scale that measures degree of incapacity/ dependence and mortality after neurological events) by a physician with no knowledge of treatment allocation. The main hypothesis is that, once compared with standard of care, glibenclamide 3.75mg will provide better clinical outcome and additionally will decrease mortality and improve quality of life and cognitive performance after 90 days.

Sample size: Previous studies have shown that the NSE mean for the third day after subarachnoid hemorrhage is 21 ng/ml, the standard deviation is about 3 ng/ml, and the third day NSE in patients with a good prognosis group is about 19 ng/ml, and the standard deviation is about 3 ng/ml; according to the two-sided test, significance of 5%, two groups of equal number of people, 90% of the degree of certainty, the calculation of the sample size of 98 cases, assuming 10% of the loss of visits, the total sample size is expected to be 110 cases.

• Study Type: Interventional
• Enrollment (Anticipated): 110
• Phase: Phase 4

Contacts and Locations

• Study Contact: Name: qing lin; Phone Number: 13811127173; Email: 13811127173@163.com

Study Locations

• China
  • Beijing
    • Beijing, Beijing, China, 100050
      • Recruiting
      • Beijing Tiantan Hospital Affiliated to Capital Medical University
      • Contact: qing lin; Phone Number: 13811127173; Email: 13811127173@163.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Subarachnoid hemorrhage was diagnosed by digital subtraction angiography, computed tomographic angiogram or magnetic resonance angiography;
2. Within 48 hours;
3. Age > 18 years old;
4. The expected length of stay is more than 7 days;
5. Sign informed consent.

Exclusion Criteria:

1. There was a history of taking sulfonylureas within 30 days before brain injury;
2. Combined with neurological or mental diseases, including stroke, epilepsy and dementia;
3. Hunt & Hess grade V patients;
4. Severe brain injury (central hernia or hook hernia within 48 hours after admission or after resuscitation) that cannot be solved at present;
5. History of alcohol or illicit drug dependence;
6. Allergic to sulfonamides or glibenclamide tablets;
7. The international normalized ratio was more than 1.4;
8. Renal insufficiency, history of dialysis treatment or serum creatinine more than 2.5 mg / dl;
9. Liver cirrhosis or severe liver dysfunction (ALT > 2.5 times the upper normal limit or total bilirubin > 1.5 times the upper normal limit);
10. He is taking bosentan tablets to treat pulmonary hypertension;
11. There was a history of glucose-6-phosphate dehydrogenase deficiency (faba bean disease);
12. The life expectancy is less than one year;
13. The gastrointestinal tract should not be used;
14. Pregnancy or lactation;
15. History of participating in other drug trials within 30 days;
16. There were clinical conditions that other researchers did not consider to meet the inclusion criteria.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Experimental group; Glibenclamide was given orally or through nasogastric tube, 1.25 mg every 8 hours for 7 days	Drug: glibenclamide; Glibenclamide was given orally or by nasal feeding; Other Names: Glebenzene
No Intervention: Control group; No glibenclamide treatment

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from Baseline Serum neuron-specific enolase（NSE）	change of NSE serum concentrations after treatment	at 1st, 3rd,7th days after recruitment
Change from Baseline Serum S100 β	change of S100B serum concentrations after treatment	at 1st, 3rd,7th days after recruitment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intracranial pressure	if have	up to 7 days
The proportion of modified Rankin score (0-2)	The proportion of modified Rankin score (0-2)	at 90 days
The degree of brain edema	showed by brain CT	on the 3rd and 7th day after medication
The incidence of delayed cerebral ischemia	The incidence of delayed cerebral ischemia	up to 3 weeks
The incidence of hypoglycemia	The incidence of hypoglycemia	up to 7 days

Collaborators and Investigators

• Sponsor: Beijing Tiantan Hospital
• Collaborators: Beijing Tongren Hospital
• Investigators: Study Chair: guangzhi shi, doctor, Beijing Tiantan Hospital

Study record dates

Study Major Dates

• Study Start (Actual): October 19, 2021
• Primary Completion (Anticipated): October 19, 2022
• Study Completion (Anticipated): December 1, 2022

Study Registration Dates

• First Submitted: October 19, 2021
• First Submitted That Met QC Criteria: November 16, 2021
• First Posted (Actual): November 30, 2021

Study Record Updates

• Last Update Posted (Actual): February 14, 2022
• Last Update Submitted That Met QC Criteria: February 7, 2022
• Last Verified: February 1, 2022

More Information

Terms related to this study

• Keywords: Subarachnoid hemorrhage; Glibenclamide; Brain aneurysms
• Additional Relevant MeSH Terms: Pathologic Processes; Cardiovascular Diseases; Vascular Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Intracranial Hemorrhages; Hemorrhage; Subarachnoid Hemorrhage; Hypoglycemic Agents; Physiological Effects of Drugs; Glyburide
• Other Study ID Numbers: glibenclamide study group2

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No