A recent Oxford University-led study reviewed over 150 clinical trials in hopes of presenting a comprehensive comparative analysis of 30 drug treatments for insomnia. Findings of the study show that many common insomnia treatments lack long-term safety data, and popular treatments, like melatonin, have little clinical evidence of their effectiveness.
Insomnia and Drug Treatment Safety and Effectivity
Andrea Cipriani, lead researcher, and professor at the Department of Psychiatry, explains that the team looked at both published and unpublished information to achieve a transparent and comprehensive picture of all data. He adds that it is evident that insomnia needs to be treated effectively since it can affect a patient's health, home, and the wider health system.
The journal The Lancet, "Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis, " included data gathered from 154 double-blind, randomized controlled trials that had more than 44,000 participants. Thirty pharmacological treatments for insomnia were also examined for their effectiveness and side effects for acute and long-term usage.
The study's findings pointed to two drugs demonstrating the most effective treatment profiles: eszopiclone and leborexant. More common insomnia drugs like zolpidem and benzodiazepines were found to be helpful only in the short term; however, they lacked evidence for efficacy and safety for a long time.
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Truth Behind Insomnia Treatments
Researchers concluded that considering the outcomes at different time points, lemborexant and eszopiclone had the best efficacy, acceptability, and tolerability profiles. On the other hand, eszopiclone may have substantial adverse effects, and safety data on lemborexant were inconclusive.
Likewise, both drugs are yet to be approved in the EU. Lemborexant is a novel type of insomnia drug, only approved in the US in 2019, NewAtlas reports. The coauthor of the study, Philip Cowen, says that mechanisms of action used by lemborexant may still be improved for better treatment of insomnia.
Researchers also found that a popular treatment, melatonin, had poor efficacy data and few long-term studies. The lack of long-term data, in general, was highlighted in the study as a problem considering that the condition is often persistent, requiring treatment for long periods.
Cipriani clearly states that the study only focuses on pharmacological interventions for insomnia. Lifestyle and behavioral interventions were not included in the meta-analysis before, alongside any drug treatment.
Cipriani explains that the study does not recommend that drugs should always be used as the first life of support in treating insomnia, not least because some treatments can have serious side effects. However, the study shows that some of the drugs available can also be effective and should be used in clinical practice only when appropriate, for example, in treatments where Cognitive Behavioral Therapy and improved sleep hygiene have not worked or for patients who want to consider taking medication as their primary treatment.
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