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Abstract T P318: Impact of Pre-stroke Sulphonylurea and Metformin Use on Outcome of Intracerebral Hemorrhage


 Background and Purpose:
 There is currently no effective treatment for intracerebral hemorrhage (ICH). Preliminary evidence suggests sulphonylurea may be protective in ischemic stroke. Metformin reduced post stroke lactate generation in an animal model. Our objective was to assess the effects of sulphonylurea and metformin use at time of stroke onset on ICH outcome.
 
 
 Methods:
 We merged patient data from the consecutive single-center Helsinki ICH Study and the ICH arm of the pooled repository of trials Virtual International Trials Archive (VISTA-ICH). Logistic regression adjusting for known predictors of ICH outcome estimated the association of pre-stroke exposure to metformin and sulphonylurea with all-cause 90-day mortality. Ordinal shift analysis for 90-day mRS was performed with the same covariates in the VISTA dataset only.
 
 
 Results:
 After excluding cases with missing data (n=190) we included 1810 patients (Helsinki n=961, VISTA-ICH n=849), of whom 478 (26%) died by 90 days. Of the 289 (16%) diabetic patients, 100 (34.6%) used metformin and 78 (27%) sulphonylurea at ICH onset. After adjusting for age, sex, baseline GCS, NIHSS, volume, infratentorial location, intraventricular extension, and pre-ICH warfarin use, there was no association with sulphonylurea (OR 1.22; 95% CI 0.63-2.40;p=0.55) or metformin (OR 0.69;0.36-1.33;p=0.27) use with 90-day mortality. When restricted to the diabetic subgroup, metformin use was associated with lower 90-day mortality (OR 0.44;0.20-0.97;p=0.041) while sulphonylurea was not (OR 0.90;0.41-1.96;p=0.79). In the ordinal shift analysis neither metformin nor sulphonylurea influenced 90-day mRS in the whole dataset (p>0.5), although in the diabetic subgroup there was a trend towards improved outcome with metformin use (0.7 point reduction;-0.1-1.5;p=0.09). Conclusion: Sulphonylurea or metformin use at time of stroke was not associated with outcome in all ICH patients but there was a signal of lower mortality and possibly improved functional outcome with metformin use in diabetic patients. The protective effect of metformin might be a result of improved glycemic control or reduced lactate generation. Our results generate hypotheses which after further validation may be tested in clinical trials.
