Efficacy and safety of insomnia pharmacotherapies: Convergent evidence from Bayesian network meta-regression and FAERS-based disproportionality analysis
Abstract
BACKGROUND: Medications, including dual orexin receptor antagonists (DORAs), benzodiazepines (BZDs), Z-drugs and melatonin receptor agonists, are common medications for insomnia disorder, but holistic comparisons of their efficacy and safety are not quite clear.
OBJECTIVE: To investigate the efficacy and safety profiles of agents for treating insomnia disorder and further establish a clinical algorithm in terms of type of insomnia based on the "time window" generated from adjusting for certain confounding factors.
METHODS: Relevant randomized controlled trials (RCTs) were retrieved from PubMed, Embase, Scopus, the Cochrane Library, Web of Science, and ClinicalTrials.gov from inception to April 15, 2025. The standard mean difference (SMD) was generated for consecutive variants, including the wake after sleep onset(WASO), latency to persistent sleep(LPS), total sleep time(TST), and sleep efficiency(SE), for pairwise comparisons via Bayesian network meta-regression (NMR) analyses adjusted for the follow-up period and age by RStudio 4.4.2. Pharmacovigilance (PV) was investigated by leveraging the FAERS database, and odds ratios (ORs) were generated for dichotomous and ordinal variants for pairwise comparisons via STATA 18.0 MP.
RESULT: A total of 15 studies evaluating 10 treatment regimens involving 2408 patients were included in the final analysis. For the WASO, compared with the placebo group, dimdazenil 2.5 mg/d (SMD = -0.388, 95 % CI: -0.608 to -0.166), lemborexant 10 mg/d…
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: 2,408 participants or records.
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