Sodium Oxybate for Narcolepsy with Cataplexy: Systematic Review and Meta-Analysis

Alshaikh, Mashael; Tricco, Andrea C.; Tashkandi, Mariam; Mamdani, Muhammad; Straus, Sharon E.; BaHammam, Ahmed S.

doi:10.5664/jcsm.2048

Cited by 76 publications

(40 citation statements)

References 33 publications

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“…Moreover, it is important to highlight the fact that therapeutic doses of GHB are effectively used in a myriad of conditions such as narcolepsy, alcohol dependence, and possibly fibromyalgia (Alshaikh et al, ; Calandre, Rico‐Villademoros, & Slim, ; van den Brink et al, ). Though, it is worth mentioning that the doses used recreationally by the GHB‐NoComa group were considerably higher than the therapeutic GHB concentrations generally used for these conditions.…”

Section: Discussionmentioning

confidence: 99%

Recreational use of GHB is associated with alterations of resting state functional connectivity of the central executive and default mode networks

Pereira

Zhutovsky

McMaster

et al. 2019

Human Brain Mapping

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Gamma‐hydroxybutyrate acid (GHB) is a recreational drug with a high addictive potential. Severe side effects such as GHB‐induced coma are common and linked to increased emergency room attendances. Task‐based functional‐imaging studies have revealed an association between the regular use of GHB and multiple GHB‐induced comas, and altered neurocognitive function. However the effects of multiple GHB‐induced comas and regular GHB‐use on intrinsic brain connectivity during rest remain unknown. The study population consisted of 23 GHB‐users with ≥4 GHB‐induced comas (GHB‐Coma), 22 GHB‐users who never experienced a GHB‐induced coma (GHB‐NoComa) and 24 polydrug users who never used GHB (No‐GHB). Resting‐state scans were collected to assess resting‐state functional‐connectivity within and between the default mode network (DMN), the bilateral central executive network (CEN) and the salience network (SN). The GHB‐NoComa group showed decreased rsFC of the right CEN with a region in the anterior cingulate cortex ( p FWE = 0.048) and decreased rsFC between the right CEN and the DMN ( p FWE = 0.048) when compared with the No‐GHB group. These results suggest that regular GHB‐use is associated with decreased rsFC within the right CEN and between the right CEN and the DMN. The presence of multiple GHB‐induced comas is not associated with (additional) alterations in rsFC.

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Section: Discussionmentioning

confidence: 99%

Recreational use of GHB is associated with alterations of resting state functional connectivity of the central executive and default mode networks

Pereira

Zhutovsky

McMaster

et al. 2019

Human Brain Mapping

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“…It may also act via specific non-GABAergic receptors; it also reduces dopamine release. Sodium oxybate (SXB) is first-line therapy for daytime sleepiness and cataplexy 16,33. It may improve HH and SP; it may also help consolidate nocturnal sleep.…”

Section: Managementmentioning

confidence: 99%

New developments in the management of narcolepsy

Abad

Guilleminault

2017

NSS

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Narcolepsy is a life-long, underrecognized sleep disorder that affects 0.02%–0.18% of the US and Western European populations. Genetic predisposition is suspected because of narcolepsy’s strong association with HLA DQB1*06-02, and genome-wide association studies have identified polymorphisms in T-cell receptor loci. Narcolepsy pathophysiology is linked to loss of signaling by hypocretin-producing neurons; an autoimmune etiology possibly triggered by some environmental agent may precipitate hypocretin neuronal loss. Current treatment modalities alleviate the main symptoms of excessive daytime somnolence (EDS) and cataplexy and, to a lesser extent, reduce nocturnal sleep disruption, hypnagogic hallucinations, and sleep paralysis. Sodium oxybate (SXB), a sodium salt of γ hydroxybutyric acid, is a first-line agent for cataplexy and EDS and may help sleep disruption, hypnagogic hallucinations, and sleep paralysis. Various antidepressant medications including norepinephrine serotonin reuptake inhibitors, selective serotonin reuptake inhibitors, and tricyclic antidepressants are second-line agents for treating cataplexy. In addition to SXB, modafinil and armodafinil are first-line agents to treat EDS. Second-line agents for EDS are stimulants such as methylphenidate and extended-release amphetamines. Emerging therapies include non-hypocretin-based therapy, hypocretin-based treatments, and immunotherapy to prevent hypocretin neuronal death. Non-hypocretin-based novel treatments for narcolepsy include pitolisant (BF2.649, tiprolisant); JZP-110 (ADX-N05) for EDS in adults; JZP 13-005 for children; JZP-386, a deuterated sodium oxybate oral suspension; FT 218 an extended-release formulation of SXB; and JNJ-17216498, a new formulation of modafinil. Clinical trials are investigating efficacy and safety of SXB, modafinil, and armodafinil in children. γ-amino butyric acid (GABA) modulation with GABAA receptor agonists clarithromycin and flumazenil may help daytime somnolence. Other drugs investigated include GABAB agonists (baclofen), melanin-concentrating hormone antagonist, and thyrotropin-releasing hormone agonists. Hypocretin-based therapies include hypocretin peptide replacement administered either through an intracerebroventricular route or intranasal route. Hypocretin neuronal transplant and transforming stem cells into hypothalamic neurons are also discussed in this article. Immunotherapy to prevent hypocretin neuronal death is reviewed.

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“…[5] They were later replaced by modafinil as firstline treatment. [8] Due to its short half-life, it must, however,b e dosed twice nightly. [6] Amongo thers, modafinil acts on the dopaminergic system and decreasest he GA-BAergico utflow from the ventrolateral preoptic area (VLPO).…”

Section: Introductionmentioning

confidence: 99%

The Discovery of LML134, a Histamine H3 Receptor Inverse Agonist for the Clinical Treatment of Excessive Sleep Disorders

et al. 2019

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Histamine H3 receptor (H3R) inverse agonists that have been in clinical trials for the treatment of excessive sleep disorders, have been plagued with insomnia as a mechanism‐based side effect. We focused on the identification of compounds that achieve high receptor occupancy within a short time, followed by rapid disengagement from the receptor, a target profile that could provide therapeutic benefits without the undesired side effect of insomnia. This article describes the optimization work that led to the discovery of 1‐(1‐methyl‐6‐oxo‐1,6‐dihydropyridazin‐3‐yl)piperidin‐4‐yl 4‐cyclobutylpiperazine‐1‐carboxylate (18 b, LML134).

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Sodium Oxybate for Narcolepsy with Cataplexy: Systematic Review and Meta-Analysis

Cited by 76 publications

References 33 publications

Recreational use of GHB is associated with alterations of resting state functional connectivity of the central executive and default mode networks

Recreational use of GHB is associated with alterations of resting state functional connectivity of the central executive and default mode networks

New developments in the management of narcolepsy

The Discovery of LML134, a Histamine H3 Receptor Inverse Agonist for the Clinical Treatment of Excessive Sleep Disorders

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