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
In brief
Methylprednisolone boosts 90-day recovery odds by 25% in men after thrombectomy
In a secondary analysis of 1,680 stroke patients, men who received methylprednisolone during endovascular clot removal were 25% more likely to achieve better functional scores at 90 days and also showed lower death and bleeding rates, while women had no measurable benefit. The sex interaction was not statistically significant, so further trials are needed to confirm these findings.
- Journal
- Therapeutic advances in neurological disorders (Q1)
- Published
- 31 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Lijiao Zhang, Jie Pan, Lilan Wang, Chunye Chen, Mingrui Zhou, Sheng Zhou, et al.
- PMID
- 42542723
- DOI
- 10.1177/17562864261473898
Why clinicians should know about it
- Picked for Neurology (clinical) (paper of the day, 3 August 2026).
Abstract
BACKGROUND: Sex-based differences in treatment response to neuroprotective strategies during endovascular treatment (EVT) for acute ischemic stroke remain poorly understood. OBJECTIVES: This study aimed to evaluate sex-specific effects of methylprednisolone on outcomes after EVT for acute ischemic stroke due to large vessel occlusion. DESIGN: Secondary analysis of the MARVEL (Methylprednisolone as Adjunct to Endovascular Thrombectomy for Large-Vessel Occlusion Stroke) randomized controlled trial. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. REGISTRATION: ChiCTR.org.cn Identifier: ChiCTR2100051729.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.