Efficacy and safety of vestibular suppressants in patients with BPPV compared to placebo, no treatment, or canalith repositioning maneuvers (CRMs).
Study design: Meta-analysis of randomized controlled trials (RCTs)
Population
- Number of patients studied: 296
- Inclusion criteria: RCTs comparing antihistamines, phenothiazines, anticholinergics, and/or benzodiazepines to placebo, no treatment, or a CRM in patients with BPPV
- Exclusion criteria: Non-randomized studies, studies without a control group, and studies without relevant outcomes
Interventions
- Experimental group: Vestibular suppressants (antihistamines, phenothiazines, anticholinergics, and/or benzodiazepines)
- Control group: Placebo, no treatment, or CRM
Primary outcome: Symptom resolution at the point of longest follow-up (14-31 days)
Secondary outcomes
- Symptom resolution within 24 hours: MD 5 points (95% CI -16.92 to 26.94)
- Repeat emergency department (ED)/clinic visits: RR 0.37 (95% CI 0.12 to 1.15)
- Patient satisfaction: MD 0 points (95% CI -1.02 to 1.02)
- Quality of life: MD -1.2 points (95% CI -2.96 to 0.56)
Conclusion
In patients with BPPV, vestibular suppressants may have no effect on symptom resolution at the point of longest follow-up, while CRMs may be superior. Vestibular suppressants have uncertain effects on symptom resolution within 24 hours, repeat ED/clinic visits, patient satisfaction.