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Melatonin Receptor Agonists for the Prevention of Delirium: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: Although a previous review illustrated the efficacy of melatonin receptor agonists (MRAs) in preventing delirium, some recent randomized controlled trials (RCTs) did not confirm these effects. Objectives: This study systematically reviewed the efficacy, acceptability, and tolerability of...

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Autores principales: Maneeton, Benchalak, Kongsaengdao, Subsai, Maneeton, Narong, Likhitsathian, Surinporn, Woottiluk, Pakapan, Kawilapat, Suttipong, Srisurapanont, Manit
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bentham Science Publishers 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9886800/
https://www.ncbi.nlm.nih.gov/pubmed/35524672
http://dx.doi.org/10.2174/1570159X20666220507024219
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author Maneeton, Benchalak
Kongsaengdao, Subsai
Maneeton, Narong
Likhitsathian, Surinporn
Woottiluk, Pakapan
Kawilapat, Suttipong
Srisurapanont, Manit
author_facet Maneeton, Benchalak
Kongsaengdao, Subsai
Maneeton, Narong
Likhitsathian, Surinporn
Woottiluk, Pakapan
Kawilapat, Suttipong
Srisurapanont, Manit
author_sort Maneeton, Benchalak
collection PubMed
description Background: Although a previous review illustrated the efficacy of melatonin receptor agonists (MRAs) in preventing delirium, some recent randomized controlled trials (RCTs) did not confirm these effects. Objectives: This study systematically reviewed the efficacy, acceptability, and tolerability of MRAs for delirium prevention. Materials and Methods: We searched electronic databases, including Scopus, PubMed, CINAHL, and Controlled Trials Register, from their inception to February 20, 2022. The primary efficacy outcome was delirium incidence rate after MRA administration; relative risks (RRs), overall discontinuation, and discontinuation due to adverse events are also presented. Results: The overall pooled incidence rates of delirium in MRA-treated and placebo-treated groups were significantly different with RR (95% CI)=0.66(0.52, 0.84,), I(2)=59%. Similarly, the incidence rate was significantly lower in the melatonin-treated group than in the placebo-treated group [RR (95% CI) =0.65 (0.49, 0.88), I(2)=65%]. Unfortunately, incidence rates were not significantly different between ramelteon-treated and placebo-treated groups [RR (95% CI) =0.67 (0.42, 1.08), I(2)=50%]. The pooled incidence rate of delirium in either melatonin or ramelteon-treated groups was not significantly different from the placebo-treated group in elderly patients. The pooled incidence rate of delirium was significantly lower in the melatonin-treated group than in the benzodiazepine-treated group. Conclusion: Based on this review, melatonin could prevent delirium with a small effect size. However, ramelteon did not show efficacy in preventing delirium. Additionally, neither melatonin nor ramelteon individually showed effectiveness in preventing delirium in elderly patients. Therefore, using MRAs to prevent delirium in clinical practice should be cautious. However, future well-defined and large sample size studies could verify these findings.
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spelling pubmed-98868002023-02-28 Melatonin Receptor Agonists for the Prevention of Delirium: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials Maneeton, Benchalak Kongsaengdao, Subsai Maneeton, Narong Likhitsathian, Surinporn Woottiluk, Pakapan Kawilapat, Suttipong Srisurapanont, Manit Curr Neuropharmacol Neurology Background: Although a previous review illustrated the efficacy of melatonin receptor agonists (MRAs) in preventing delirium, some recent randomized controlled trials (RCTs) did not confirm these effects. Objectives: This study systematically reviewed the efficacy, acceptability, and tolerability of MRAs for delirium prevention. Materials and Methods: We searched electronic databases, including Scopus, PubMed, CINAHL, and Controlled Trials Register, from their inception to February 20, 2022. The primary efficacy outcome was delirium incidence rate after MRA administration; relative risks (RRs), overall discontinuation, and discontinuation due to adverse events are also presented. Results: The overall pooled incidence rates of delirium in MRA-treated and placebo-treated groups were significantly different with RR (95% CI)=0.66(0.52, 0.84,), I(2)=59%. Similarly, the incidence rate was significantly lower in the melatonin-treated group than in the placebo-treated group [RR (95% CI) =0.65 (0.49, 0.88), I(2)=65%]. Unfortunately, incidence rates were not significantly different between ramelteon-treated and placebo-treated groups [RR (95% CI) =0.67 (0.42, 1.08), I(2)=50%]. The pooled incidence rate of delirium in either melatonin or ramelteon-treated groups was not significantly different from the placebo-treated group in elderly patients. The pooled incidence rate of delirium was significantly lower in the melatonin-treated group than in the benzodiazepine-treated group. Conclusion: Based on this review, melatonin could prevent delirium with a small effect size. However, ramelteon did not show efficacy in preventing delirium. Additionally, neither melatonin nor ramelteon individually showed effectiveness in preventing delirium in elderly patients. Therefore, using MRAs to prevent delirium in clinical practice should be cautious. However, future well-defined and large sample size studies could verify these findings. Bentham Science Publishers 2022-08-31 2022-08-31 /pmc/articles/PMC9886800/ /pubmed/35524672 http://dx.doi.org/10.2174/1570159X20666220507024219 Text en © 2022 Bentham Science Publishers https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.
spellingShingle Neurology
Maneeton, Benchalak
Kongsaengdao, Subsai
Maneeton, Narong
Likhitsathian, Surinporn
Woottiluk, Pakapan
Kawilapat, Suttipong
Srisurapanont, Manit
Melatonin Receptor Agonists for the Prevention of Delirium: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials
title Melatonin Receptor Agonists for the Prevention of Delirium: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_full Melatonin Receptor Agonists for the Prevention of Delirium: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_fullStr Melatonin Receptor Agonists for the Prevention of Delirium: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_full_unstemmed Melatonin Receptor Agonists for the Prevention of Delirium: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_short Melatonin Receptor Agonists for the Prevention of Delirium: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_sort melatonin receptor agonists for the prevention of delirium: an updated systematic review and meta-analysis of randomized controlled trials
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9886800/
https://www.ncbi.nlm.nih.gov/pubmed/35524672
http://dx.doi.org/10.2174/1570159X20666220507024219
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