JAMA

International Stroke Conference: Adjunctive corticosteroid therapy does not improve outcomes after stroke

February 14, 2024

In this randomized, double-blind, placebo-controlled trial from China (dubbed the MARVEL trial), researchers found that a short course of low-dose methylprednisolone added to endovascular thrombectomy after acute ischemic stroke did not improve outcomes overall, though there was a lower rate of mortality. The findings were presented at the International Stroke Conference in early February.

• The Methylprednisolone as Adjunctive to Endovascular Treatment for Acute Large Vessel Occlusion (MARVEL) trial was performed at 82 hospitals in China and enrolled 1,680 patients with stroke and proximal intracranial large-vessel occlusion, presenting within 24 hours of time last known to be well.
• The primary efficacy outcome was disability level at 90 days as measured by the overall distribution of the modified Rankin Scale scores (range, 0 [no symptoms] to 6 [death]). The primary safety outcomes included mortality at 90 days and the incidence of symptomatic intracranial hemorrhage within 48 hours.
• Among 1,680 patients randomized (median age, 69 years; 43.3% female), 1,673 (99.6%) completed the trial.
• The median 90-day modified Rankin Scale score was 3 in the methylprednisolone group versus 3 in the placebo group (adjusted generalized odds ratio for a lower level of disability, 1.10 [95% CI, 0.96-1.25]; P = .17).
• In the methylprednisolone group, there was a lower mortality rate (23.2% vs 28.5%; adjusted risk ratio, 0.84 [95% CI, 0.71-0.98]; P = .03) and a lower rate of symptomatic intracranial hemorrhage (8.6% vs 11.7%; adjusted risk ratio, 0.74 [95% CI, 0.55-0.99]; P = .04) compared with placebo.

Source:

MARVEL Trial Authors for the MARVEL Investigators. (2024, February 8). JAMA. Methylprednisolone as Adjunct to Endovascular Thrombectomy for Large-Vessel Occlusion Stroke: The MARVEL Randomized Clinical Trial.  https://jamanetwork.com/journals/jama/fullarticle/2814940