Efficacy of Ramelteon, Suvorexant, and Lemborexant for Delirium Prevention in Hospitalized Patients: A Systematic Review and Meta-Analysis
Abstract
OBJECTIVES
Delirium is a prevalent complication among hospitalized patients, particularly in older adults and ICU populations, and it is associated with poor prognosis. Pharmacologic interventions targeting sleep-wake regulation and neurobiologic pathways, such as orexin receptor antagonists and melatonin receptor agonists, offer promising strategies for delirium prevention. Our objective was to evaluate the preventive efficacy of suvorexant, lemborexant, and ramelteon in reducing delirium prevalence and associated clinical outcomes.
DATA SOURCES
We systematically searched PubMed, Embase, Cochrane Central Register of Controlled Trials, clinical trial registries, and gray literature databases through November 2024.
STUDY SELECTION
Randomized controlled trials or observational studies involving hospitalized adults assessing the use of suvorexant, lemborexant, or ramelteon for delirium prevention were included.
DATA EXTRACTION
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane guidelines, two reviewers extracted data independently. Quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation; Risk of Bias in Randomized Studies; and Risk of Bias in Nonrandomized Studies-of Interventions tools. Random-effects meta-analysis pooled risk ratios (RRs) and median differences with 95% CIs.
DATA SYNTHESIS
Twenty-four studies involving 4489 patients were analyzed, of whom 1752 (39%) received one of the evaluated…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 4,489 participants or records.
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