Sleep Disorders: Sleep Disorders 1 |

Comparative Efficacy of Treatments for Restless Legs Syndrome: A Network Meta-analysis FREE TO VIEW

Lana Alghothani; Imran Iftikhar, MBBS
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Emory University, Atlanta, GA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1267A. doi:10.1016/j.chest.2016.08.1381
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SESSION TITLE: Sleep Disorders 1

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: While several randomized controlled trials (RCTs) have studied the efficacy of individual treatment options for Restless Legs Syndrome (RLS), only a few have directly compared the various treatments to one another. We therefore sought to compare the relative efficacies of dopamine agonists (pramipexole, ropinirole, and rotigotine), gabapentin enacarbil, pre-gabalin, iron, and exercise training with each other, via a network meta-analysis, using International RLS scale (IRLS) scores as the primary endpoint.

METHODS: Eligible RCTs were shortlisted from PubMed and SCOPUS. Network meta-analysis using frequentist method was performed in R program version using package ‘netmeta’ with random effects models. Ranking of treatments for efficacy was based on P scores, which are based solely on the point estimates and standard errors of the network estimates.

RESULTS: A total of 29 RCTs were analyzed. Pramipexole, ropinirole and rotigotine decreased IRLS scores by -4.43 (95% CIs: -5.88 to -2.97), -3.97 (95%CIs: -5.55 to -2.39), and -4.59 (95% CIs: -6.29 to -2.88), respectively. Gabapentin enacarbil and pre-gabalin decreased IRLS scores by -4.58 (95% CIs: -6.81 to -2.35) and -4.41 (95% CIs: -6.46 to -2.37), respectively. While iron supplementation decreased IRLS by -4.52 ((5% CIs: -8.80 to -0.25), exercise training resulted in a -7.30 (95% CIs: -11.75 to -2.86) decrease in IRLS scores. No significant inter-treatment differences in IRLS scores were detected. P-score ranking places exercise training as most efficacious, followed by rotigotine, gabapentin enacarbil, iron, pramipexole, pre-gabalin, and ropinirole.

CONCLUSIONS: While dopamine agonists, gabapentin enacarbil, pre-gabalin, and iron are equally efficacious in the treatment of RLS, exercise training elicited the most significant reduction in IRLS scores.

CLINICAL IMPLICATIONS: Since most dopamine agonists are associated with augmentation with increasing doses, non-dopamine agonists, such as gabapentin enacarbil and pre-gabalin which are not significantly associated with augmentation, can be considered as alternatives. Furthermore, exercise training can be a useful adjunct to any of the pharmacological options.

DISCLOSURE: The following authors have nothing to disclose: Lana Alghothani, Imran Iftikhar

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