PMID- 37257468
OWN - NLM
STAT- MEDLINE
DCOM- 20230602
LR  - 20230612
IS  - 1678-4227 (Electronic)
IS  - 0004-282X (Print)
IS  - 0004-282X (Linking)
VI  - 81
IP  - 5
DP  - 2023 May
TI  - Dual orexin receptor antagonists for the treatment of insomnia: systematic review 
      and network meta-analysis.
PG  - 475-483
LID - 10.1055/s-0043-1768667 [doi]
AB  - BACKGROUND: Several randomized clinical trials (RCTs) have shown that dual orexin 
      receptor antagonists (DORAs) are effective in the treatment of chronic insomnia. 
      However, the superiority of one particular DORA over the others remains unclear. 
      OBJECTIVE: To perform a network meta-analysis to evaluate the efficacy of 
      different DORAs in patients with chronic insomnia. METHODS: The Medline, Embase, 
      and Cochrane Central databases were searched for RCTs that compared DORA with 
      placebo in patients >/= 18 years of age with a diagnosis of insomnia disorder. We 
      pooled outcomes for wake time after sleep onset (WASO), latency to persistent 
      sleep (LPS), total sleep time (TST), and adverse events (AEs). RESULTS: We 
      included 10 RCTs with 7,806 patients, 4,849 of whom received DORAs as the 
      intervention. Overall, we found that DORAs were associated with the improvement 
      of all analyzed efficacy outcomes. Concerning TST, an apparent dose-dependent 
      pattern was noticed, with higher doses relating to a longer TST. Lemborexant 10mg 
      provided the largest reduction in WASO (at month 1) in minutes (standardized mean 
      difference [SMD] = -25.40; 95% confidence interval [95%CI] = -40.02--10.78), 
      followed by suvorexant 20/15mg (SMD = -25.29; 95%CI = -36.42--14.15), which also 
      appeared to provide the largest decrease in long-term WASO (SMD = -23.70; 
      95%CI = -35.89--11.51). The most frequent AEs were somnolence, nasopharyngitis, 
      and headache, with rates of up to 14.8%. CONCLUSION: Our results suggest that 
      DORAs are associated with greater efficacy when compared with placebo in the 
      treatment of insomnia, a complex 24-hour sleep disorder. Additionally, dosing 
      might play an important role in the management of chronic insomnia.
CI  - Academia Brasileira de Neurologia. This is an open access article published by 
      Thieme under the terms of the Creative Commons Attribution 4.0 International 
      License, permitting copying and reproduction so long as the original work is 
      given appropriate credit (https://creativecommons.org/licenses/by/4.0/).
FAU - Rocha, Rebeka Bustamante
AU  - Rocha RB
AUID- ORCID: 0000-0001-8689-5148
AD  - Universidade Federal do Amazonas, Faculdade de Medicina, Manaus AM, Brazil.
FAU - Bomtempo, Fernanda Ferreira
AU  - Bomtempo FF
AUID- ORCID: 0000-0001-7268-6695
AD  - Faculdade de Ciencias Medicas de Minas Gerais, Faculdade de Medicina, Belo 
      Horizonte MG, Brazil.
FAU - Nager, Gabriela Borges
AU  - Nager GB
AUID- ORCID: 0000-0003-0604-4154
AD  - Universidade Federal do Estado do Rio de Janeiro, Faculdade de Medicina, Rio de 
      Janeiro RJ, Brazil.
FAU - Cenci, Giulia Isadora
AU  - Cenci GI
AUID- ORCID: 0000-0002-4236-1096
AD  - Faculdade Meridional, Faculdade de Medicina, Passo Fundo RS, Brazil.
FAU - Telles, Joao Paulo Mota
AU  - Telles JPM
AUID- ORCID: 0000-0001-9322-0405
AD  - Universidade de Sao Paulo, Faculdade de Medicina, Departamento de Neurologia, Sao 
      Paulo SP, Brazil.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
TT  - Antagonistas duais do receptor de orexina para o tratamento da insonia: revisao 
      sistematica e metanalise em rede.
DEP - 20230531
PL  - Germany
TA  - Arq Neuropsiquiatr
JT  - Arquivos de neuro-psiquiatria
JID - 0125444
RN  - 0 (Orexin Receptor Antagonists)
SB  - IM
MH  - Humans
MH  - *Sleep Initiation and Maintenance Disorders/drug therapy
MH  - Orexin Receptor Antagonists/therapeutic use/pharmacology
MH  - Network Meta-Analysis
MH  - Sleep
MH  - Wakefulness
PMC - PMC10232020
COIS- The authors have no conflict of interest to declare.
EDAT- 2023/06/01 01:08
MHDA- 2023/06/02 06:42
PMCR- 2023/05/01
CRDT- 2023/05/31 18:52
PHST- 2023/06/02 06:42 [medline]
PHST- 2023/06/01 01:08 [pubmed]
PHST- 2023/05/31 18:52 [entrez]
PHST- 2023/05/01 00:00 [pmc-release]
AID - ANP-22-0213 [pii]
AID - 10.1055/s-0043-1768667 [doi]
PST - ppublish
SO  - Arq Neuropsiquiatr. 2023 May;81(5):475-483. doi: 10.1055/s-0043-1768667. Epub 
      2023 May 31.