A new pharmacological approach of the treatment of vertigo of vascular etiology

Boniver, R

doi:10.1515/9783110845655-024

Cited by 1 publication

(7 citation statements)

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“…A high ROB was found for blinding in 4 studies, 26,28,36,37 for selective outcomes reporting in 3 studies, 22,32,33 and for attrition bias in 2 studies. 32,33 Main Results…”

Section: Quality Assessmentmentioning

confidence: 96%

“…Seventeen studies [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] with a total of 1586 participants contributed to the quantitative results (Table 2). These studies spanned 11 countries and 6 languages and each enrolled between 18 and 200 patients.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…The following antihistamines were used: 2 studies administered betahistine, 4 cinnarizine, 7 dimenhydrinate, 2 flunarizine, 1 meclizine, and 2 promethazine. Antihistamines were compared with benzodiazepines in 3 studies, 21,29,35 with placebo or no treatment in 7 studies, 22,23,26,28,33,36,37 and with other active controls in 6 studies. The only benzodiazepines studied were lorazepam and diazepam, which were compared with placebo in 1 trial 30 and with antihistamines in 3 trials.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…In 8 studies, 21,24,25,27,29,31,34 medications were given as a single dose, and results were provided on immediate outcomes at 30 minutes to 2 hours. In the remaining 9 studies, 22,23,26,28,30,32,33,[35][36][37] medications were given enterally for 1 week to 2 months.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…One trial 27 had a high ROB for blinding but low risk in all other domains, and the other 34 had unclear ROB in all domains except blinding. Of the 9 trials 22,23,26,28,30,32,33,36,37 that reported 1-week or 1-month outcomes, all had a high ROB.…”

Section: Quality Assessmentmentioning

confidence: 99%

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Efficacy of Benzodiazepines or Antihistamines for Patients With Acute Vertigo

et al. 2022

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IMPORTANCE Acute vertigo can be disabling. Antihistamines and benzodiazepines are frequently prescribed as "vestibular suppressants," but their efficacy is unclear.OBJECTIVE To assess the efficacy of antihistamines and benzodiazepines in the treatment of acute vertigo from any underlying cause.DATA SOURCES We searched the PubMed, CENTRAL, EMBASE, CINAHL, Scopus, and ClinicalTrials.gov databases from inception to January 14, 2019, without language restrictions. Bibliographies of the included studies and relevant reviews were also screened. STUDY SELECTIONWe included randomized clinical trials (RCTs) comparing antihistamine or benzodiazepine use with another comparator, placebo, or no intervention for patients with a duration of acute vertigo for 2 weeks or less. Studies of healthy volunteers, prophylactic treatment, or induced vertigo were excluded, as were studies that compared 2 medications from the same class. DATA EXTRACTION AND SYNTHESIS Following Preferred Reporting Items for SystematicReviews and Meta-analyses (PRISMA) guidelines, data were extracted and risk of bias was assessed by 2 authors independently for each study. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURESThe predefined primary outcome was change in 10-or 100-point vertigo or dizziness visual analog scale (VAS) scores at 2 hours after treatment. Secondary outcomes included change in nausea VAS scores at 2 hours, use of rescue medication at 2 hours, and improvement or resolution of vertigo at 1 week or 1 month. RESULTSOf the 27 trials identified in the systematic review, 17 contributed to the quantitative meta-analysis and involved a total of 1586 participants. Seven trials with a total of 802 participants evaluated the primary outcome of interest: single-dose antihistamines resulted in significantly more improvement on 100-point VAS scores compared with benzodiazepines (difference, 16.1 [95% CI, 7.2 to 25.0]) but not compared with other active comparators (difference, 2.7 [95% CI, -6.1 to 11.5]). At 1 week and 1 month, neither daily benzodiazepines nor antihistamines were reported to be superior to placebo. RCTs comparing the immediate effects of medications (at 2 hours) after a single dose generally had a low risk of bias, but those evaluating 1-week and 1-month outcomes had a high risk of bias. CONCLUSIONS AND RELEVANCEModerately strong evidence suggests that single-dose antihistamines provide greater vertigo relief at 2 hours than single-dose benzodiazepines. Furthermore, the available evidence did not support an association of benzodiazepine use with improvement in any outcomes for acute vertigo. Other evidence suggested that daily antihistamine use may not benefit patients with acute vertigo. Larger randomized trials comparing both antihistamines and benzodiazepines with placebo could better clarify the relative efficacy of these medications.

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“…A high ROB was found for blinding in 4 studies, 26,28,36,37 for selective outcomes reporting in 3 studies, 22,32,33 and for attrition bias in 2 studies. 32,33 Main Results…”

Section: Quality Assessmentmentioning

confidence: 96%