嗜睡
医学
安慰剂
科克伦图书馆
荟萃分析
原发性失眠
随机对照试验
失眠症
内科学
不利影响
睡眠障碍
精神科
替代医学
病理
作者
Tao Xue,Xin Wu,Shujun Chen,Yanbo Yang,Zeya Yan,Zhaoming Song,Wei Zhang,Jianguo Zhang,Zhouqing Chen,Zhong Wang
标识
DOI:10.1016/j.smrv.2021.101573
摘要
The efficacy and safety of dual orexin receptor antagonists (DORAs) for primary insomnia have been well verified in several large randomized controlled trials (RCTs) over the past several decades. However, there have been few systematic comparisons of different DORAs, and the best DORA for insomniacs has remained unclear. Here, Medline, Embase, Cochrane library, and clinicaltrials.gov were searched for RCTs (through December 31, 2020) to evaluate different DORAs versus a placebo. We pooled data from 13 RCTs. DORAs were superior to the placebo in all efficacy outcomes except the subjective number of awakenings (P = 0.90), but also showed higher risks of somnolence, abnormal dreams, fatigue, and dry mouth (somnolence: P < 0.00001; abnormal dreams: P = 0.03; fatigue: P = 0.001; dry mouth: P = 0.007). No statistical differences were found between any two of the DORAs in terms of primary efficacy outcomes. However, lemborexant yielded the three-highest surfaces under the curve ranking area (SUCRA) values (78.25%, 96.25% and 89.13%). Taken together, we conclude that DORAs are superior to the placebo in terms of efficacy and safety measures.
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