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Nervenheilkunde 2022; 41(11): 783-788
DOI: 10.1055/a-1910-9858
Schwerpunkt

Evidenzbasierte Schwindeltherapie

Metaanalyse randomisierter Primärstudien zur PharmakotherapieEvidence-based vertigo therapyMeta-analysis of randomized primary pharmacotherapy trials
Frank Waldfahrer
1   Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Universitätsklinikum Erlangen
,
Arne W. Scholtz
2   Klinik für Hals-, Nasen- und Ohrenheilkunde, Medizinische Universität Innsbruck, Österreich
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ZUSAMMENFASSUNG

Das Ziel der vorliegenden Metaanalyse war es, die Wirksamkeit und Sicherheit der Fixkombination aus Cinnarizin 20 mg und Dimenhydrinat 40 mg im Vergleich zu anderen Antivertiginosa bei Patienten mit zentralem und/oder peripherem vestibulärem Schwindel zu untersuchen. Hierzu wurden die individuellen Patientendaten von 4 randomisierten, doppelblinden, kontrollierten klinischen Studien mit nahezu identischem Studiendesign, zusammengeführt. Insgesamt wurden die Daten von 795 Patienten mit Schwindel verschiedener Genese (zentral- und/oder peripher-vestibulär) in die Analyse einbezogen.

In allen 4 Studien wurden die Patienten 4 Wochen mit der Testmedikation (Fixkombination aus Cinnarizin 20 mg und Dimenhydrinat 40 mg), mit verschiedenen Vergleichsmedikationen (Cinnarizin 20 mg, 50 mg, Dimenhydrinat 40 mg, 100 mg, Betahistin-Dimesilat 12 mg, Betahistin-Dihydrochlorid 16 mg) oder einem Placebo behandelt. Als Hauptzielkriterium der Metaanalyse diente die Veränderung der Schwindelsymptomatik nach 4-wöchiger Behandlung. Die subjektiven Schwindelbeschwerden der Patienten wurden mit Hilfe eines validierten Schwindel-Scores (mittlerer Vertigo Score, MVS) ermittelt. Die Nebenzielkriterien umfassten verschiedene Ansprechraten, die Veränderung der vegetativen Begleitsymptomatik und die Beurteilung der Wirksamkeit und Verträglichkeit durch Untersucher und Patienten.

Zusammenfassend deuten die Ergebnisse der vorliegenden Metaanalyse darauf hin, dass die Fixkombination aus Cinnarizin 20 mg und Dimenhydrinat 40 mg bei zentralem und/oder peripherem Schwindel eine potenziell überlegene Behandlungsoption mit besserer Wirksamkeit im Vergleich zu anderen Antivertiginosa bei gleichzeitig guter Verträglichkeit ist.

ABSTRACT

The aim of the present meta-analysis was to evaluate the efficacy and safety of the fixed combination of cinnarizine 20 mg and dimenhydrinate 40 mg in comparison with various other antivertigo treatments in patients with central and/or peripheral vestibular vertigo. For this purpose, individual patient data from 4 randomised, double-blind, controlled clinical trials with almost identical study design were pooled. In total, the data of 795 patients with vertigo of different origin (central and/or peripheral-vestibular) were included in the analysis. In all 4 included studies, patients were treated for 4 weeks with the test medication (fixed combination of cinnarizine 20 mg and dimenhydrinate 40 mg), with different comparators (cinnarizine 20 mg, 50 mg, dimenhydrinate 40 mg, 100 mg, betahistine dimesylate 12 mg, betahistine dihydrochloride 16 mg) or a placebo. The main outcome of the meta-analysis was the change in vertigo symptoms after 4 weeks of treatment. Patients’ subjective vertigo symptoms were assessed using a validated vertigo score (Mean Vertigo Score, MVS). Secondary outcome measures included various response rates, change in concomitant vegetative symptoms and investigator and patient ratings of efficacy and tolerability.

In summary, the results of the present meta-analysis suggest that the fixed combination of cinnarizine 20 mg and dimenhydrinate 40 mg is a potentially superior treatment option for central and/or peripheral vertigo, with significantly better efficacy compared to other antivertigo treatments while being well tolerated.

Schlüsselwörter

Metaanalyse - evidenzbasiert - Pharmakotherapie - Schwindel - Cinnarizin - Dimenhydrinat

Key words

Meta-analysis - evidence-based - pharmacotherapy - vertigo - cinnarizin - dimenhydrinat


Publication History

Article published online:
11 November 2022

© 2022. Thieme. All rights reserved.

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