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Peer-reviewedCC BY 4.0Frontiers in Endocrinology

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

  • Lei Zhang1
  • Beibei Zhang2,3,4,5
  • Lingyu Zhang6
  • Kaiyuan Feng7
  • Linyu Li8
  • Haoxuan Zhu7,9
  • Xu Xu7
  • Jinfu Ma7
  • Sheng Zhou10
  • Zhixi Wang7
  • Jiayu Li7
  • Qiuyi Yang7
8 more authors
  • Yian Chen7
  • Mingyang Chen7
  • Yihui Yang7
  • Yuhan Fan7
  • Junjie Yuan7
  • Jiaxing Song8
  • Gaoming Li7
  • Mingrui Zhou11
11 affiliations
  1. 1Department of Neurosurgery, The People's Hospital of Qiandongnan Miao and Dong Autonomous Prefecture
  2. 2Department of Encephalopathy, Hubei Provincial Hospital of Traditional Chinese Medicine
  3. 3Hubei Key Laboratory of theory and application research of liver and kidney in traditional Chinese medicine, Affiliated Hospital of Hubei University of Chinese Medicine
  4. 4Hubei Shizhen Laboratory
  5. 5Hubei Province Academy of Traditional Chinese Medicine
  6. 6Department of Neurology, The Second Hospital & Clinical Medical School, Lanzhou University
  7. 7Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University)
  8. 8Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University
  9. 9Department of Neurology, The 908th Hospital of Chinese People’s Liberation Army Joint Logistic Support Force
  10. 10Department of Neurology, Renhuai People’s Hospital
  11. 11The First Clinical Medical School, Hubei University of Chinese Medicine
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Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{zhang2026outcomes,
  title = {{Outcomes of methylprednisolone as an adjunct to endovascular therapy in patients with diabetes and admission hyperglycemia}},
  author = {Lei Zhang and Beibei Zhang and Lingyu Zhang and Kaiyuan Feng and Linyu Li and Haoxuan Zhu and Xu Xu and Jinfu Ma and Sheng Zhou and Zhixi Wang and Jiayu Li and Qiuyi Yang and Yian Chen and Mingyang Chen and Yihui Yang and Yuhan Fan and Junjie Yuan and Jiaxing Song and Gaoming Li and Mingrui Zhou},
  journal = {Frontiers in Endocrinology},
  year = {2026},
  month = oct,
  doi = {10.3389/fendo.2026.1932813},
  url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1932813/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Outcomes of methylprednisolone as an adjunct to endovascular therapy in patients with diabetes and admission hyperglycemia
AU  - Lei Zhang
AU  - Beibei Zhang
AU  - Lingyu Zhang
AU  - Kaiyuan Feng
AU  - Linyu Li
AU  - Haoxuan Zhu
AU  - Xu Xu
AU  - Jinfu Ma
AU  - Sheng Zhou
AU  - Zhixi Wang
AU  - Jiayu Li
AU  - Qiuyi Yang
AU  - Yian Chen
AU  - Mingyang Chen
AU  - Yihui Yang
AU  - Yuhan Fan
AU  - Junjie Yuan
AU  - Jiaxing Song
AU  - Gaoming Li
AU  - Mingrui Zhou
PY  - 2026
DA  - 2026/10/08
JO  - Frontiers in Endocrinology
DO  - 10.3389/fendo.2026.1932813
UR  - https://www.frontiersin.org/articles/10.3389/fendo.2026.1932813/full
AB  - 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.
SN  - 1664-2392
ER  -