Emerging Pharmacological Treatments for Cerebral Edema: Evidence from Clinical Studies

Abstract

Cerebral edema, a common and often fatal companion to most forms of acute central nervous system disease, has been recognized since the time of ancient Egypt. Unfortunately, our therapeutic armamentarium remains limited, in part due to historic limitations in our understanding of cerebral edema pathophysiology. Recent advancements have led to a number of clinical trials for novel therapeutics that could fundamentally alter the treatment of cerebral edema. In this review, we discuss these agents, their targets, and the data supporting their use, with a focus on agents that have progressed to clinical trials.

Keywords: antiedema drug; cerebral edema; clinical trial.

Figure 1

(a,b) Axial brain T2 fluid-attenuated inversion recovery MRI images from the Glyburide Advantage in Malignant Edema and Stroke study (NCT01794182) showing midline (red bar) shift in patients with large middle cerebral artery territory ischemic stroke who were given intravenous (IV) (a) glyburide or (b) placebo. (c) Graph showing the reduced median midline shift in patients given IV glyburide, with boxes depicting interquartile range, whiskers representing 10th to 90th percentiles, and bars showing 95% confidence intervals. Figure adapted with permission from Reference 43.