Vestibular suppressants for benign paroxysmal positional vertigo : A systematic review and meta-analysis of randomized controlled trials
© 2022 Society for Academic Emergency Medicine..
BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is a common cause of acute dizziness. Medication use for its treatment remains common despite guideline recommendations against their use.
OBJECTIVES: The objective was to evaluate the efficacy and safety of vestibular suppressants in patients with BPPV compared to placebo, no treatment, or canalith repositioning maneuvers (CRMs).
METHODS: We searched MEDLINE, Cochrane, EMBASE, and ClinicalTrials.gov from inception until March 25, 2022. for randomized controlled trials (RCTs) comparing antihistamines, phenothiazines, anticholinergics, and/or benzodiazepines to placebo, no treatment, or a CRM.
RESULTS: Five RCTs, enrolling 296 patients, were included in the quantitative analysis. We found that vestibular suppressants may have no effect on symptom resolution at the point of longest follow-up (14-31 days in four studies) when evaluated as a continuous outcome (standardized mean difference -0.03 points, 95% confidence interval [CI] -0.53 to 0.47). Conversely, CRMs may improve symptom resolution at the point of longest follow-up as a dichotomous outcome when compared to vestibular suppressants (relative risk [RR] 0.63, 95% CI 0.52 to 0.78). Vestibular suppressants had an uncertain effect on symptom resolution within 24 h (mean difference [MD] 5 points, 95% CI -16.92 to 26.94), repeat emergency department (ED)/clinic visits (RR 0.37, 95% CI 0.12 to 1.15), patient satisfaction (MD 0 points, 95% CI -1.02 to 1.02), and quality of life (MD -1.2 points, 95% CI -2.96 to 0.56). Vestibular suppressants had an uncertain effect on adverse events.
CONCLUSIONS: In patients with BPPV, vestibular suppressants may have no effect on symptom resolution at the point of longest follow-up; however, there is evidence toward the superiority of CRM over these medications. Vestibular suppressants have an uncertain effect on symptom resolution within 24 h, repeat ED/clinic visits, patient satisfaction, quality of life, and adverse events. These data suggest that a CRM, and not vestibular suppressants, should be the primary treatment for BPPV.
| Errataetall: |
CommentIn: Ann Intern Med. 2023 Apr;176(4):JC47. - PMID 37011392 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:30 |
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| Enthalten in: |
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine - 30(2023), 5 vom: 21. Mai, Seite 541-551 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Sharif, Sameer [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 12.05.2023 Date Revised 30.05.2023 published: Print-Electronic CommentIn: Ann Intern Med. 2023 Apr;176(4):JC47. - PMID 37011392 Citation Status MEDLINE |
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| doi: |
10.1111/acem.14608 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
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| 100 | 1 | |a Sharif, Sameer |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Vestibular suppressants for benign paroxysmal positional vertigo |b A systematic review and meta-analysis of randomized controlled trials |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 12.05.2023 | ||
| 500 | |a Date Revised 30.05.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Ann Intern Med. 2023 Apr;176(4):JC47. - PMID 37011392 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022 Society for Academic Emergency Medicine. | ||
| 520 | |a BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is a common cause of acute dizziness. Medication use for its treatment remains common despite guideline recommendations against their use | ||
| 520 | |a OBJECTIVES: The objective was to evaluate the efficacy and safety of vestibular suppressants in patients with BPPV compared to placebo, no treatment, or canalith repositioning maneuvers (CRMs) | ||
| 520 | |a METHODS: We searched MEDLINE, Cochrane, EMBASE, and ClinicalTrials.gov from inception until March 25, 2022. for randomized controlled trials (RCTs) comparing antihistamines, phenothiazines, anticholinergics, and/or benzodiazepines to placebo, no treatment, or a CRM | ||
| 520 | |a RESULTS: Five RCTs, enrolling 296 patients, were included in the quantitative analysis. We found that vestibular suppressants may have no effect on symptom resolution at the point of longest follow-up (14-31 days in four studies) when evaluated as a continuous outcome (standardized mean difference -0.03 points, 95% confidence interval [CI] -0.53 to 0.47). Conversely, CRMs may improve symptom resolution at the point of longest follow-up as a dichotomous outcome when compared to vestibular suppressants (relative risk [RR] 0.63, 95% CI 0.52 to 0.78). Vestibular suppressants had an uncertain effect on symptom resolution within 24 h (mean difference [MD] 5 points, 95% CI -16.92 to 26.94), repeat emergency department (ED)/clinic visits (RR 0.37, 95% CI 0.12 to 1.15), patient satisfaction (MD 0 points, 95% CI -1.02 to 1.02), and quality of life (MD -1.2 points, 95% CI -2.96 to 0.56). Vestibular suppressants had an uncertain effect on adverse events | ||
| 520 | |a CONCLUSIONS: In patients with BPPV, vestibular suppressants may have no effect on symptom resolution at the point of longest follow-up; however, there is evidence toward the superiority of CRM over these medications. Vestibular suppressants have an uncertain effect on symptom resolution within 24 h, repeat ED/clinic visits, patient satisfaction, quality of life, and adverse events. These data suggest that a CRM, and not vestibular suppressants, should be the primary treatment for BPPV | ||
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| 650 | 4 | |a benzodiazepines | |
| 650 | 4 | |a clinical trial | |
| 650 | 4 | |a phenothiazines | |
| 650 | 4 | |a randomized | |
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| 700 | 1 | |a Upadhye, Suneel |e verfasserin |4 aut | |
| 700 | 1 | |a Edlow, Jonathan A |e verfasserin |4 aut | |
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