Zheng Xijun, He Yingchun, Yin Fang, Liu Hongxia, Li Yunfei, Zheng Qingshan, Li Lujin
Center for Drug of Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Center for Drug of Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Sleep Med. 2020 Aug;72:41-49. doi: 10.1016/j.sleep.2020.03.022. Epub 2020 Apr 1.
Although different forms of pharmacological intervention are often prescribed for insomnia disorder, the comparative efficacies among various drugs remain unclear. We therefore conducted this study to quantitatively compare the efficacy of various pharmacotherapies for insomnia by modeling.
We searched PubMed, EMBASE and Cochrane Library databases for randomized placebo-controlled trials of insomnia medications that were conducted within a designated time period (from the inception dates to May 16, 2019). Pharmacodynamic models were established to describe the time course of changes from baseline in selected sleep parameters. Sleep quality and dropout rates were also compared by a single-arm meta-analysis.
In sum, 43 studies covering 44 trials (14,535 patients) were included in the analysis. The drugs evaluated included flurazepam, quazepam, temazepam, triazolam, eszopiclone, zaleplon, zolpidem, extended-release zolpidem, suvorexant, ramelteon and doxepin. The established models revealed eszopiclone had the highest efficacy in terms of sleep latency (SL), total sleep time (TST), and sleep quality, and was also associated with the lowest dropout rates. The effect of suvorexant on the parameter 'wake after sleep onset' (WASO) was significantly higher than that of the other drugs analyzed.
Each drug has its own characteristics in the treatment of insomnia, and this needs to be taken into consideration to meet individual clinical needs. These results serve as a quantitative supplement for clinical practice by reflecting the difference in efficacy of various drugs in the treatment of insomnia.
尽管针对失眠症常常会开出不同形式的药物干预处方，但各种药物之间的相对疗效仍不明确。因此，我们开展了这项研究，通过建模对各种药物治疗失眠的疗效进行定量比较。
我们在PubMed、EMBASE和Cochrane图书馆数据库中检索了在指定时间段内（从起始日期至2019年5月16日）进行的失眠药物随机安慰剂对照试验。建立药效学模型以描述选定睡眠参数相对于基线的变化时间过程。还通过单臂荟萃分析比较了睡眠质量和脱落率。
总计，分析纳入了43项研究，涵盖44项试验（14535名患者）。评估的药物包括氟西泮、夸西泮、替马西泮、三唑仑、艾司佐匹克隆、扎来普隆、唑吡坦、缓释唑吡坦、苏沃雷生、雷美替胺和多塞平。所建立的模型显示，在睡眠潜伏期（SL）、总睡眠时间（TST）和睡眠质量方面，艾司佐匹克隆的疗效最高，且脱落率也最低。苏沃雷生对“睡眠后觉醒”（WASO）参数的影响显著高于所分析的其他药物。
每种药物在治疗失眠方面都有其自身特点，需要考虑这些特点以满足个体临床需求。这些结果通过反映各种药物在治疗失眠方面的疗效差异，为临床实践提供了定量补充。
