Sodium oxybate for narcolepsy with cataplexy: systematic review and meta-analysis.

Abstract

STUDY OBJECTIVES:

To assess the efficacy and safety of sodium oxybate (SXB) in narcolepsy-cataplexy patients.

DESIGN:

Systematic review and meta-analysis.

PATIENTS:

Adults with narcolepsy-cataplexy.

INTERVENTIONS:

SXB.

MEASUREMENTS AND RESULTS:

Electronic databases (e.g., MEDLINE) and references of included studies were searched to identify randomized controlled trials (RCTs) assessing the efficacy and safety of SXB for patients with narcolepsy-cataplexy. Risk of bias was appraised using the Cochrane risk of bias tool. Meta-analysis was conducted in Review Manager Version 5. Six RCTs and 5 companion reports were included after screening 14 full-text articles and 483 citations. All were private-industry funded. SXB (usually 9 g/night) was superior to placebo for reducing mean weekly cataplexy attacks (n = 2 RCTs, mean difference [MD]: -8.5, 95% CI: -15.3, -1.6), increasing maintenance wakefulness test (MWT) (n = 2, MD: 5.18, 95% CI: 2.59-7.78), reducing sleep attacks (n = 2, MD: -9.65, 95% CI: -17.72, -1.59), and increasing Clinical Global Impression scores (n = 3, relative risk, RR: 2.42, 95% CI: 1.77-3.32). SXB did not significantly increase REM sleep versus placebo (n = 2, MD: -0.49, 95% CI: -3.90, 2.92). Patients receiving SXB had statistically more adverse events versus placebo, including nausea (n = 3, relative risk [RR]: 7.74, 95% CI: 3.2, 19.2), vomiting (n = 2, RR: 11.8, 95% CI: 1.6, 89.4), and dizziness (n = 3, RR: 4.3, 95% CI: 1.1, 16.4). Enuresis was not significantly different from placebo (n = 2, RR: 2.6, 95% CI: 0.8, 9.8). All meta-analyses had minimal statistical heterogeneity (p-value > 0.1).

CONCLUSION:

Narcolepsy patients on SXB have significant reductions in cataplexy and daytime sleepiness. SXB is well tolerated in patients with narcolepsy, and most adverse events were mild to moderate in severity.

• Authors: Mashael K Alshaikh, Andrea C Tricco, Mariam Tashkandi, Muhammad Mamdani, Sharon E Straus, Ahmed S BaHammam
• Journal: Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine (J Clin Sleep Med) Vol. 8 Issue 4 Pg. 451-8 (Aug 15 2012) ISSN: 1550-9397 [Electronic] United States
• PMID: 22893778 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)

Chemical References

• Sodium Oxybate

Topics

• Adult
• Female
• Humans
• Male
• Narcolepsy (drug therapy)
• Polysomnography
• Sodium Oxybate (antagonists & inhibitors, therapeutic use)
• Treatment Outcome