Melatonin and Ramelteon for the treatment of delirium: A systematic review and meta-analysis.

Autor: Beaucage-Charron J; Department of Pharmacy, Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est-de-l'Île-de-Montréal, Montréal, Canada. Electronic address: johannie.beaucage-charron.cemtl@ssss.gouv.qc.ca., Rinfret J; Department of Pharmacy, Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est-de-l'Île-de-Montréal, Montréal, Canada., Coveney R; Direction of Education, Research and Innovation, Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est-de-l'Île-de-Montréal, Montréal, Canada., Williamson D; Department of Pharmacy, Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Canada; Faculty of Pharmacy, Université de Montréal, Montréal, Canada.
Jazyk: angličtina
Zdroj: Journal of psychosomatic research [J Psychosom Res] 2023 Jul; Vol. 170, pp. 111345. Date of Electronic Publication: 2023 May 01.
DOI: 10.1016/j.jpsychores.2023.111345
Abstrakt: Objective: To assess the efficacy of melatonin and melatonergic agonist for the treatment of delirium in hospitalized patients.
Methods: Embase, MEDLINE, PsycINFO, PubMed, CENTRAL, Cochrane Database of Systematic Reviews, TRIP Medical Database, ClinicalTrials.gov and Google were searched from inception to October 2022. Randomized controlled trials (RCT) and observational studies with any type of comparator evaluating melatonin or melatonergic agonist (ramelteon) enrolling any populations (ICU, surgery, geriatric) were included. Two reviewers independently selected and extracted data using the Cochrane risk of bias tools (RoB2 and ROBINSI).
Results: Out of the 650 screened publications, three RCTs and six observational studies were included (n = 1211). All three RCTs compared melatonin to placebo, as the majority of observational studies compared melatonin or ramelteon to antipsychotics. Two RCTs reported the duration of delirium and a meta-analysis provided a statistical difference between melatonin and placebo (-1.72 days, 95% CI -2.66 to -0.77, p = 0.0004). Five observational studies reported the duration of delirium but only one reported a statistical reduction in the duration of delirium.
Conclusion: Although melatonin and ramelteon may be effective treatments for delirium, particularly to shorten the duration of delirium and to limit the use of rescue medication, current data is limited in number and in its quality. Clinicians should wait until higher quality data from ongoing RCTs are available before prescribing melatonin to delirious patients.
Competing Interests: Declaration of Competing Interest No conflicting interests to declare.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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