Sex-specific effects of methylprednisolone on outcomes after endovascular treatment for acute ischemic stroke due to large vessel occlusion: A secondary analysis of the MARVEL trial.

内容摘要

Sex-based differences in treatment response to neuroprotective strategies during endovascular treatment (EVT) for acute ischemic stroke remain poorly understood. This study aimed to evaluate sex-specific effects of methylprednisolone on outcomes after EVT for acute ischemic stroke due to large vessel occlusion. Secondary analysis of the MARVEL (Methylprednisolone as Adjunct to Endovascular Thrombectomy for Large-Vessel Occlusion Stroke) randomized controlled trial. We compared outcomes following methylprednisolone versus placebo, stratified by sex. We also compared outcomes between women and men receiving methylprednisolone. The primary outcome was defined as the 90-day modified Rankin Scale score (mRS) ordinal shift. Secondary outcomes included mRS score of 0-4, 0-3, 0-2, 0-1 at 90 days. Safety outcomes included mortality within 90 days and symptomatic intracranial hemorrhage (sICH) within 48 hours. This study included 1680 patients (49.9% methylprednisolone, 56.7% men). Stratified by sex, among men, the methylprednisolone group was more likely to have a primary outcome compared with placebo [adjusted OR (aOR) 1.26 (1.00-1.59), P = 0.047] and reduce mortality (P < 0.01) and sICH (P = 0.031); among women, the primary outcome was similar between two treatment arms (P = 0.66), with similar findings for the safety outcomes. Additionally, stratified by different treatment arms, no significant difference was found in the primary outcome between men and women treated with methylprednisolone (P = 0.31) and placebo (P = 0.68). In this exploratory analysis, methylprednisolone appeared to be associated with better clinical outcomes in men compared with placebo. Nevertheless, the interaction between treatment and sex was not statistically significant. Furthermore, among patients receiving methylprednisolone, clinical outcomes did not differ significantly between men and women. ChiCTR.org.cn Identifier: ChiCTR2100051729. This study looked at whether an anti-inflammatory drug called methylprednisolone has different effects in men and women who had a severe stroke caused by a large blood clot in a brain artery and underwent a procedure called endovascular treatment to remove the clot. The research was based on data from a large clinical trial that included 1,680 patients. About half received methylprednisolone and the other half received a placebo. The researchers compared outcomes between men and women who received the drug versus placebo, and also directly compared men and women who received the drug. The results showed that among men, those who received methylprednisolone had better recovery of daily functions 90 days after the stroke compared to men who received placebo. They also had lower rates of death and symptomatic bleeding in the brain. Among women, however, there was no significant difference in recovery between those who received methylprednisolone and those who received placebo. When researchers directly compared men and women who both received methylprednisolone, their recovery outcomes were not significantly different. In summary, this study suggests that methylprednisolone may be more helpful for recovery in men with this type of stroke, while the benefit in women was less clear. These findings indicate that sex may be an important factor to consider when using this medication in future stroke treatment.