Cargando…
Pharmacological Interventions for Excessive Daytime Sleepiness in Adults with Narcolepsy: A Systematic Review and Network Meta-Analysis
Narcolepsy is a neurological disease characterized by a core symptom of excessive daytime sleepiness (EDS). Although effective pharmacological interventions for narcolepsy have been developed, a lack of comparative evidence supporting the relative efficacy among these medications leads to clinical t...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9654433/ https://www.ncbi.nlm.nih.gov/pubmed/36362535 http://dx.doi.org/10.3390/jcm11216302 |
_version_ | 1784828930694316032 |
---|---|
author | Chien, Po-Yu Kuo, Chan-Yen Lin, Meng-Hsuan Chang, Yao-Jen Hung, Chin-Chuan |
author_facet | Chien, Po-Yu Kuo, Chan-Yen Lin, Meng-Hsuan Chang, Yao-Jen Hung, Chin-Chuan |
author_sort | Chien, Po-Yu |
collection | PubMed |
description | Narcolepsy is a neurological disease characterized by a core symptom of excessive daytime sleepiness (EDS). Although effective pharmacological interventions for narcolepsy have been developed, a lack of comparative evidence supporting the relative efficacy among these medications leads to clinical treatment challenge. Therefore, we performed a network meta-analysis to overcome this lack of head-to-head comparisons. Databases were searched systematically for randomized controlled trials that compared pharmacological interventions for narcolepsy. The primary outcomes were changes in the Epworth Sleepiness Scale (ESS) and the Maintenance of Wakefulness Test (MWT). A random-effects frequentist network meta-analysis was conducted. A total of 19 RCTs involving 2504 patients were included. Solriamfetol achieved the highest ranking based on the P-scores, and was superior to pitolisant (MD −2.88, 95% CI −4.89–−0.88) and sodium oxybate (MD −2.56, 95% CI −4.62–−0.51) for ESS change. Consistently, solriamfetol achieved the highest ranking according to MWT change, and was superior to pitolisant (SMD 0.45, 95% CI 0.02–0.88) and modafinil (SMD 0.42, 95% CI 0.05–0.79). Although solriamfetol demonstrated superior efficacy in EDS improvement, evidence from the clustered ranking plot supported that efficacy–safety profiles of pitolisant, sodium oxybate, and modafinil are more balanced than solriamfetol. Therefore, the choice of medication for EDS in narcolepsy should be made on an individual basis. |
format | Online Article Text |
id | pubmed-9654433 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-96544332022-11-15 Pharmacological Interventions for Excessive Daytime Sleepiness in Adults with Narcolepsy: A Systematic Review and Network Meta-Analysis Chien, Po-Yu Kuo, Chan-Yen Lin, Meng-Hsuan Chang, Yao-Jen Hung, Chin-Chuan J Clin Med Article Narcolepsy is a neurological disease characterized by a core symptom of excessive daytime sleepiness (EDS). Although effective pharmacological interventions for narcolepsy have been developed, a lack of comparative evidence supporting the relative efficacy among these medications leads to clinical treatment challenge. Therefore, we performed a network meta-analysis to overcome this lack of head-to-head comparisons. Databases were searched systematically for randomized controlled trials that compared pharmacological interventions for narcolepsy. The primary outcomes were changes in the Epworth Sleepiness Scale (ESS) and the Maintenance of Wakefulness Test (MWT). A random-effects frequentist network meta-analysis was conducted. A total of 19 RCTs involving 2504 patients were included. Solriamfetol achieved the highest ranking based on the P-scores, and was superior to pitolisant (MD −2.88, 95% CI −4.89–−0.88) and sodium oxybate (MD −2.56, 95% CI −4.62–−0.51) for ESS change. Consistently, solriamfetol achieved the highest ranking according to MWT change, and was superior to pitolisant (SMD 0.45, 95% CI 0.02–0.88) and modafinil (SMD 0.42, 95% CI 0.05–0.79). Although solriamfetol demonstrated superior efficacy in EDS improvement, evidence from the clustered ranking plot supported that efficacy–safety profiles of pitolisant, sodium oxybate, and modafinil are more balanced than solriamfetol. Therefore, the choice of medication for EDS in narcolepsy should be made on an individual basis. MDPI 2022-10-26 /pmc/articles/PMC9654433/ /pubmed/36362535 http://dx.doi.org/10.3390/jcm11216302 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Chien, Po-Yu Kuo, Chan-Yen Lin, Meng-Hsuan Chang, Yao-Jen Hung, Chin-Chuan Pharmacological Interventions for Excessive Daytime Sleepiness in Adults with Narcolepsy: A Systematic Review and Network Meta-Analysis |
title | Pharmacological Interventions for Excessive Daytime Sleepiness in Adults with Narcolepsy: A Systematic Review and Network Meta-Analysis |
title_full | Pharmacological Interventions for Excessive Daytime Sleepiness in Adults with Narcolepsy: A Systematic Review and Network Meta-Analysis |
title_fullStr | Pharmacological Interventions for Excessive Daytime Sleepiness in Adults with Narcolepsy: A Systematic Review and Network Meta-Analysis |
title_full_unstemmed | Pharmacological Interventions for Excessive Daytime Sleepiness in Adults with Narcolepsy: A Systematic Review and Network Meta-Analysis |
title_short | Pharmacological Interventions for Excessive Daytime Sleepiness in Adults with Narcolepsy: A Systematic Review and Network Meta-Analysis |
title_sort | pharmacological interventions for excessive daytime sleepiness in adults with narcolepsy: a systematic review and network meta-analysis |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9654433/ https://www.ncbi.nlm.nih.gov/pubmed/36362535 http://dx.doi.org/10.3390/jcm11216302 |
work_keys_str_mv | AT chienpoyu pharmacologicalinterventionsforexcessivedaytimesleepinessinadultswithnarcolepsyasystematicreviewandnetworkmetaanalysis AT kuochanyen pharmacologicalinterventionsforexcessivedaytimesleepinessinadultswithnarcolepsyasystematicreviewandnetworkmetaanalysis AT linmenghsuan pharmacologicalinterventionsforexcessivedaytimesleepinessinadultswithnarcolepsyasystematicreviewandnetworkmetaanalysis AT changyaojen pharmacologicalinterventionsforexcessivedaytimesleepinessinadultswithnarcolepsyasystematicreviewandnetworkmetaanalysis AT hungchinchuan pharmacologicalinterventionsforexcessivedaytimesleepinessinadultswithnarcolepsyasystematicreviewandnetworkmetaanalysis |