Acute insomnia9/20/2023 ![]() ![]() Eszopiclone (OR 0.43, 95% CI 0.20-0.93) and zolpidem (OR 0.43, 95% CI 0.19-0.95) also had a lower rate of all-cause discontinuation than ramelteon for zolpidem, the rate was higher than placebo (OR 2.00, 95% CI 1.11-3.70). However, eszopiclone was associated with increased nausea and dizziness while lemborexant had increased events of headache compared to placebo. Eszopiclone and lemborexant were found to be effective for acute insomnia (standardized mean difference range 0.36-0.83) as well as chronic insomnia (eszopiclone: SMD 0.63 lemborexant: SMD 0.41 ) compared to placebo. Furthermore, patients assigned to placebo, doxepin, seltorexant, and zaleplon reported fewer side effects than those given benzodiazepines, eszopiclone, zolpidem, and zopiclone. With regard to the primary outcome of safety, more dropouts due to adverse events were reported in the zopiclone (odds ratio 2.00, 95% confidence interval 1.28-3.13) and zolpidem (OR 1.79, 95% CI 1.25-2.50) groups versus placebo. Altogether, 170 RCTs and 154 double-blind RCTs were included in the final systematic review and meta-analysis, respectively. Included were studies that used pharmacotherapy as first-line treatment for insomnia in patients ≥ 18 years, from start of databases to Nov 25, 2021. In-depth : This systematic review and meta-analysis included RCTs from Cochrane, MEDLINE, PubMed, Embase, and PsycINFO. Relevant Reading: Effect of Digital Cognitive Behavioral Therapy for Insomnia on Health, Psychological Well-being, and Sleep-Related Quality of Life: A Randomized Clinical Trial A limitation of this study is that it did not include trazodone which is one of the most common clinically used drugs for insomnia. ![]() Melatonergic drugs did not show a clear benefit over placebo. In particular, eszopiclone and lemborexant were found to be more effective for both acute and long-term insomnia treatment compared to placebo and other pharmacologic interventions. According to study results, pharmacological treatment of insomnia was associated with greater efficacy but more side effects than placebo, both in acute and long-term insomnia. Primary outcomes included safety (≥1 adverse event), efficacy (patient-reported sleep quality), and treatment discontinuation due to any cause, while key secondary outcomes were sleep onset latency period, total sleep time, and number of awakenings. This systematic review and meta-analysis aimed to study the safety and efficacy of pharmacotherapy for acute and chronic management of insomnia in adults. However, little is known about the comparative efficacies of the different pharmacological options available. Although first-line therapy for insomnia includes conservative management, studies show that pharmacological measures may help improve insomnia. Study Rundown:Insomnia is a common sleep disorder affecting 12-20% of adults worldwide. ![]()
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