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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...

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Autores principales: Chien, Po-Yu, Kuo, Chan-Yen, Lin, Meng-Hsuan, Chang, Yao-Jen, Hung, Chin-Chuan
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
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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.
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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
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