Outcomes of methylprednisolone as an adjunct to endovascular therapy in patients with diabetes and admission hyperglycemia

Background This study aimed to evaluate the effect of methylprednisolone as adjunctive treatment to endovascular therapy (EVT) in patients with and without diabetes, as well as in patients with and without admission hyperglycemia. Methods This study was a secondary analysis of the MARVEL trial. The primary outcome was the ordinal modified Rankin Scale (mRS) score at 90 days. Secondary outcomes included mRS score of 0-3, 0-2, 0–1 at 90 days. Safety outcomes included mortality within 90 days, symptomatic intracranial hemorrhage (sICH) and any ICH within 48 hours. Results Among 1,678 patients from the MARVEL trial, 321 had history of diabetes. In patients with diabetes, methylprednisolone was not associated with improved 90-day mRS [common odds radio (cOR), 1.07 (0.81-1.40), P = 0.640] but was associated with more any ICH within 48 hours [OR, 1.63 (1.17-2.26), P = 0.004]. In patients without diabetes, methylprednisolone was associated with better 90-day mRS [cOR, 1.16 (1.02-1.33), P = 0.026] and lower 90-day mortality [OR, 0.74 (0.62-0.88), P = 0.001]. A significant treatment-by-diabetes-history interaction was observed only for any ICH within 48 hours (P for interaction = 0.036). Among 1,470 patients stratified by admission hyperglycemia, methylprednisolone was not associated with improved 90-day mRS in either subgroup. Conclusion The glycemia status-by-treatment interaction was not significant. A benefit trend was observed with adjunctive methylprednisolone in patients without diabetes. However, adjunctive use of methylprednisolone in patients with diabetes may be with a higher risk of any intracranial hemorrhage. Admission hyperglycemia status did not significantly modify the effectiveness or safety of methylprednisolone. These findings warrant validation in further studies.