Sodium oxybate for narcolepsy with cataplexy: systematic review and meta-analysis.
OBJECTIVE
To assess the efficacy and safety of sodium oxybate (SXB) in narcolepsy-cataplexy patients.


METHODS
Systematic review and meta-analysis.


METHODS
Adults with narcolepsy-cataplexy.


METHODS
SXB.


RESULTS
Electronic databases (e.g., MEDLINE) and references of included studies were searched to identify randomized controlled trials (RCTs) assessing the efficacy and safety of SXB for patients with narcolepsy-cataplexy. Risk of bias was appraised using the Cochrane risk of bias tool. Meta-analysis was conducted in Review Manager Version 5. Six RCTs and 5 companion reports were included after screening 14 full-text articles and 483 citations. All were private-industry funded. SXB (usually 9 g/night) was superior to placebo for reducing mean weekly cataplexy attacks (n = 2 RCTs, mean difference [MD]: -8.5, 95% CI: -15.3, -1.6), increasing maintenance wakefulness test (MWT) (n = 2, MD: 5.18, 95% CI: 2.59-7.78), reducing sleep attacks (n = 2, MD: -9.65, 95% CI: -17.72, -1.59), and increasing Clinical Global Impression scores (n = 3, relative risk, RR: 2.42, 95% CI: 1.77-3.32). SXB did not significantly increase REM sleep versus placebo (n = 2, MD: -0.49, 95% CI: -3.90, 2.92). Patients receiving SXB had statistically more adverse events versus placebo, including nausea (n = 3, relative risk [RR]: 7.74, 95% CI: 3.2, 19.2), vomiting (n = 2, RR: 11.8, 95% CI: 1.6, 89.4), and dizziness (n = 3, RR: 4.3, 95% CI: 1.1, 16.4). Enuresis was not significantly different from placebo (n = 2, RR: 2.6, 95% CI: 0.8, 9.8). All meta-analyses had minimal statistical heterogeneity (p-value > 0.1).


CONCLUSIONS
Narcolepsy patients on SXB have significant reductions in cataplexy and daytime sleepiness. SXB is well tolerated in patients with narcolepsy, and most adverse events were mild to moderate in severity.
University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia.
Mashael K
MK
Alshaikh
Andrea C
AC
Tricco
Mariam
M
Tashkandi
Muhammad
M
Mamdani
Sharon E
SE
Straus
Ahmed S
AS
BaHammam
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D009290:Narcolepsy / Q000188:drug therapy*; D017286:Polysomnography; D012978:Sodium Oxybate / Q000037:antagonists & inhibitors* / Q000627:therapeutic use*; D016896:Treatment Outcome
D012978:Sodium Oxybate