Efficacy and tolerability of pharmacological treatments for insomnia in adults: A systematic review and network meta-analysis

作者全名："Yue, Jing-Li; Chang, Xiang -Wen; Zheng, Jun-Wei; Shi, Le; Xiang, Ya-Jie; Que, Jian-Yu; Yuan, Kai; Deng, Jia-Hui; Teng, Teng; Li, Yang-Yang; Sun, Wei; Sun, Hong-Qiang; Vitiello, Michael V.; Tang, Xiang-Dong; Zhou, Xin-Yu; Bao, Yan-Ping; Shi, Jie; Lu, Lin"

作者地址："[Yue, Jing-Li; Chang, Xiang -Wen; Shi, Le; Que, Jian-Yu; Yuan, Kai; Deng, Jia-Hui; Sun, Wei; Sun, Hong-Qiang; Lu, Lin] Peking Univ, Peking Univ Sixth Hosp, Natl Clin Res Ctr Mental Disorders, Peking Univ Inst Mental Hlth,Key Mental Hlth,Mini, Beijing, Peoples R China; [Zheng, Jun-Wei; Li, Yang-Yang; Bao, Yan-Ping; Shi, Jie; Lu, Lin] Peking Univ, Natl Inst Drug Dependence, Beijing, Peoples R China; [Zheng, Jun-Wei; Li, Yang-Yang; Bao, Yan-Ping; Shi, Jie; Lu, Lin] Peking Univ, Beijing Key Lab Drug Dependence, Beijing, Peoples R China; [Zheng, Jun-Wei; Li, Yang-Yang] Peking Univ, Sch Basic Med Sci, Dept Pharmacol, Hlth Sci Ctr, Beijing, Peoples R China; [Xiang, Ya-Jie; Teng, Teng; Zhou, Xin-Yu] Chongqing Med Univ, Affiliated Hosp 1, Dept Psychiat, Chongqing, Peoples R China; [Vitiello, Michael V.] Univ Washington, Dept Psychiat & Behav Sci, Seattle, WA USA; [Tang, Xiang-Dong] Sichuan Univ, West China Hosp, Sleep Med Ctr, Mental Hlth Ctr,Dept Resp & Crit Care Med, Chengdu, Peoples R China; [Tang, Xiang-Dong] Sichuan Univ, West China Hosp, Translat Neurosci Ctr, State Key Lab Biotherapy, Chengdu, Peoples R China; [Bao, Yan-Ping] Peking Univ, Sch Publ Hlth, Beijing, Peoples R China; [Lu, Lin] Peking Univ, McGovern Inst Brain Res, Peking Tsinghua Ctr Life Sci, Beijing, Peoples R China; [Lu, Lin] Peking Univ, McGovern Inst Brain Res, Int Data Grp, Beijing, Peoples R China"

通信作者："Lu, L (通讯作者)，Peking Univ, Peking Univ Sixth Hosp, Inst Mental Hlth, Natl Clin Res Ctr Mental Disorders,Key of Mental, Beijing 100191, Peoples R China.; Shi, J (通讯作者)，Peking Univ, Natl Inst Drug Dependence, Beijing 100191, Peoples R China.; Shi, J (通讯作者)，Peking Univ, Beijing Key Lab Drug Dependence, Beijing 100191, Peoples R China.; Bao, YP (通讯作者)，Peking Univ, Natl Inst Drug Dependence, Sch Publ Hlth, Beijing 100191, Peoples R China.; Bao, YP (通讯作者)，Peking Univ, Sch Publ Hlth, Beijing Key Lab Drug Dependence, Beijing 100191, Peoples R China."

来源：SLEEP MEDICINE REVIEWS

ESI学科分类：NEUROSCIENCE & BEHAVIOR

WOS号：WOS:000972673600001

JCR分区：Q1

影响因子：11.2

年份：2023

卷号：68

期号：　

开始页：　

结束页：　

文献类型：Review

关键词：Insomnia; Pharmacological treatments; Network meta-analysis; Objective sleep characteristics

摘要："Insomnia is one of the most common and burdensome disorders in adults. We compared and ranked insomnia medication on the basis of their efficacy and tolerability. We performed a systematic review and network meta-analysis of placebo-controlled or head-to-head randomized controlled trials for primary insomnia in adults comparing 20 drugs. We searched eight databases and seven trial registers from inception to March 1st, 2022. Primary outcomes included sleep latency (SL), awake time after sleep onset (WASO) and discontinuation for adverse events (AED), and secondary outcomes included total sleep time (TST), sleep efficiency (SE), sleep quality (SQ) and adverse events (ADE). Pooled standardized mean differences or odds ratios with 95% credible intervals were estimated using pairwise and network meta-analysis with random-effects. Differences among trial findings were explored in subgroup and sensitivity analyses. Confidence in evidence was assessed using GRADE. The PROSPERO registered number is CRD42020182144. We identified 22,538 records and included 69 studies (17,319 patients). Orexin receptor antagonists (ORAs) are more efficacious than benzodiazepine-like drugs (Z-drugs) and placebo for WASO and SE, and better than melatonin receptor agonists (MRAs) for SL, WASO and SE. ORAs ranked the best in SL (SUCRA value: 0.84), WASO (0.93), TST (0.86) and SE (0.96). Lemborexant and daridorexant (two ORAs) showed greater efficacy than placebo for SL, WASO, and TST, with good tolerability. Z-drugs were more efficacious than placebo for SL, WASO, TST and SE, but with higher risk to safety. Zaleplon and eszopiclone had better efficacy than placebo for TST and SQ respectively. MRAs may also be efficacious for sleep-onset insomnia with good safety. However, the long-term adverse effects of all medications are unclear. Insomnia medications differ in their efficacy and tolerability. ORAs have superior efficacy and toler-ability. These findings should aid clinicians in matching risk/benefits of drugs available in their countries to insomnia symptoms.(c) 2023 Elsevier Ltd. All rights reserved."

基金机构："Chinese National Programs for Brain Science and Brain-like Intelligence Technology [2021ZD0200800, 2021ZD0202100, 2021ZD0200700]; National Natural Science Foundation of China [82130040, 82001400]"

基金资助正文："Acknowledgements The authors appreciate Yan Zhang, Si-Fan Hu and Ping Dong for their help and suggestion to the meta-analysis. This work was supported by Chinese National Programs for Brain Science and Brain-like Intelligence Technology [grant number 2021ZD0200800, 2021ZD0202100, 2021ZD0200700] , and National Natural Science Foundation of China [grant number 82130040 and 82001400] ."