Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

中文翻译：

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药物治疗失眠症的干预措施：疗效的定量比较。

目的

尽管通常针对失眠症开出不同形式的药理干预措施，但各种药物之间的相对疗效仍不清楚。因此，我们进行了这项研究，以通过建模定量比较各种药物治疗失眠的功效。

方法

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.

Results

总之，分析中涵盖了43项研究，涵盖44项试验（14,535例患者）。所评估的药物包括氟西西,、奎西p，替马西m，三唑仑，埃索匹克隆，扎来普隆，唑吡坦，缓释唑吡坦，舒福生，雷美替宁和多塞平。建立的模型显示，依佐匹克隆在睡眠潜伏期（SL），总睡眠时间（TST）和睡眠质量方面具有最高的功效，并且与最低的辍学率相关。suvorexant对“入睡后唤醒”（WASO）参数的影响显着高于其他分析药物。

结论

每种药物在失眠的治疗中都有其自身的特点，因此需要考虑到这一点，以满足个人的临床需求。这些结果通过反映各种药物在失眠症治疗中的功效差异，可作为临床实践的定量补充。