Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration
BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e8343 (Published 17 December 2012) Cite this as: BMJ 2012;345:e8343All rapid responses
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Our thanks to Professor Bland for his review of our meta-analysis of non-benzodiazepine hypnotics in treatment of adult insomnia.[1,2] We have checked the original data and our analysis. We agree that the effect sizes and confidence intervals are the same in certain related trials which compare different drugs or dosages of drugs with placebo.
This is because the information provided by the individual reports was a p-value from an analysis of variance indicating that there were not significant differences across dosage levels or between drugs being compared. We used that p-value from an F-test to estimate an effect size for each case regardless of the drug or dosage. Those computations were conducted using the meta-analytic standard equations for standardized mean difference in design with independent groups using analysis of variance.[3]
References
1. Bland M. Rapid response to Huedo et al. Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration. eBMJ 15 October 2013.
2. Huedo-Medina TB, Kirsch I, Middlemass J, Klonizakis M, Siriwardena AN. Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration. BMJ 2012, 345: e8343.
3. Borenstein M. Effect sizes for continuous data. In The Handbook of Research Synthesis and Meta-Analysis. 2nd edition. Edited by Cooper HM, Hedges LV, Valentine JC. New York: Russell Sage Foundation; 2009.
Competing interests: No competing interests
I came across this paper when looking for some examples of meta-analysis.
I am fascinated by the repetitions in the data. In Fig 2, the second and third studies, LSH17 (10mg) and LSH17 (15mg), have identical estimates and confidence intervals. The 11th and 12th studies, Trial 303 (zolpidem 10mg) and Trial 303 (zaliplon 10mg), have identical estimates and confidence intervals. In Fig 3, the first and second studies, again LSH17 (10mg) and LSH17 (15mg), have identical estimates and confidence intervals. The third and fourth studies, LSH (10mg) and LSH (15mg), also have identical estimates and confidence intervals.
The authors make no comment that I can see on this staggering coincidence. Is there possibly some mistake here?
Competing interests: No competing interests
Re: Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration
We reviewed your interesting article about the efficacy of non-benzodiazepine hypnotics in the treatment of insomnia in adults. Nowadays there is a global increase in life expectancy in the adult population, especially older people in whom insomnia is a health problem and difficult to manage both diagnostically and therapeutically. We share with you the effectiveness of non-benzodiazepine hypnotics particularly Zolpidem in such treatment, always starting with low doses and increasing the dose depending on the clinical response.
Moreover we cannot forget sleep disorders as an expression of organic problems. All therapy is not without side effects, but we have to determine the risks before prescribing for each patient. The most frequent reactions reports in our series include mental confusion, falls with a range of complications. Patient assessment related to their environment, family functioning, crisis life cycle are elements to take into consideration in an adult with insomnia. Psychological support of the patient by family members, caregivers, healthcare team as well as the use of natural medicine have given us excellent results in the management of patients with insomnia.
Competing interests: No competing interests