General hospital psychiatry · 2025
Effectiveness and safety of dual orexin receptor antagonists for the prevention of delirium: A systematic review with meta-analysis and trial sequential analysis.
СтатьяМетаанализСистематический обзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Singh Swarndeep, Mathur Rahul, Chakladar Abhishek, Pal Arghya
Аннотация
PURPOSE: This systematic review and meta-analysis (SRMA) aimed to evaluate effectiveness and safety of dual orexin receptor antagonists (DORAs) for prevention of delirium.
METHODS: Medline, Web of Science, and Embase were searched to identify eligible studies published till March 2025. Review protocol was pre-registered on PROSPERO (CRD420250640168). Risk of bias was assessed using Cochrane Risk of Bias (version 2) tool for randomized-controlled trials (RCTs) and Newcastle-Ottawa Scale for non-RCTs. Random effects meta-analyses were performed with incident delirium rate as primary outcome. Trial sequential analysis (TSA) and GRADE framework were used to evaluate the strength of evidence.
RESULTS: Ten studies (3 RCTs, n = 345) involving 4342 patients were included. Incident delirium rate was significantly lower in patients receiving DORA prophylaxis compared to controls, with pooled odds ratio of 0.23 (95 % CI: 0.12 to 0.46). TSA indicated sufficiency of evidence from RCTs, but very low certainty as per GRADE framework. No beneficial effects of DORA were noted for secondary outcomes (time to onset of delirium, length of hospital or ICU stay, mortality). DORAs were apparently well tolerated, with mild adverse events of falls and hypnogogic/ hypnopompic hallucinations reported more frequently with suvorexant compared to placebo in one RCT.
CONCLUSION: DORAs, especially suvorexant showed promise for delirium prevention. However, strength of available evidence remains low due to small number of RCTs, risk of bias in several included studies, heterogeneity in observational data, and possible publication bias warranting cautious interpretation. In future, larger well-designed multinational trials are required to establish DORA use in delirium prevention.
METHODS: Medline, Web of Science, and Embase were searched to identify eligible studies published till March 2025. Review protocol was pre-registered on PROSPERO (CRD420250640168). Risk of bias was assessed using Cochrane Risk of Bias (version 2) tool for randomized-controlled trials (RCTs) and Newcastle-Ottawa Scale for non-RCTs. Random effects meta-analyses were performed with incident delirium rate as primary outcome. Trial sequential analysis (TSA) and GRADE framework were used to evaluate the strength of evidence.
RESULTS: Ten studies (3 RCTs, n = 345) involving 4342 patients were included. Incident delirium rate was significantly lower in patients receiving DORA prophylaxis compared to controls, with pooled odds ratio of 0.23 (95 % CI: 0.12 to 0.46). TSA indicated sufficiency of evidence from RCTs, but very low certainty as per GRADE framework. No beneficial effects of DORA were noted for secondary outcomes (time to onset of delirium, length of hospital or ICU stay, mortality). DORAs were apparently well tolerated, with mild adverse events of falls and hypnogogic/ hypnopompic hallucinations reported more frequently with suvorexant compared to placebo in one RCT.
CONCLUSION: DORAs, especially suvorexant showed promise for delirium prevention. However, strength of available evidence remains low due to small number of RCTs, risk of bias in several included studies, heterogeneity in observational data, and possible publication bias warranting cautious interpretation. In future, larger well-designed multinational trials are required to establish DORA use in delirium prevention.