Efficacy of pharmacologic treatment in tinnitus patients without specific or treatable origin: A network meta-analysis of randomised controlled trials

• Published in: EClinicalMedicine Vol. 39; p. 101080
• Main Authors: Chen, Jiann-Jy, Chen, Yen-Wen, Zeng, Bing-Yan, Hung, Chao-Ming, Zeng, Bing-Syuan, Stubbs, Brendon, Carvalho, Andre F., Thompson, Trevor, Roerecke, Michael, Su, Kuan-Pin, Tu, Yu-Kang, Wu, Yi-Cheng, Smith, Lee, Chen, Tien-Yu, Lin, Pao-Yen, Liang, Chih-Sung, Hsu, Chih-Wei, Hsu, Shih-Pin, Kuo, Hung-Chang, Wu, Ming-Kung, Tseng, Ping-Tao
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.09.2021; Elsevier
• Subjects: Research Paper; PAR; TRA; ALP; VES; CHL; DeGin; VAR; CLO; VAS; TRI; AMI; DeMel; MeSul; Gab; SUCRA; SMD; Gin; NOR; Car; Mel; MIS; GABA; GaLid; GRADE; VePar; Met; RR; KRG; SER; RCT; PLA; CLES; DeLid; ALVitC; THI; ClD; ACA; NMA; 95%CIs; Ozone; PRISMA; Zinc; Bet; DEX; PaVitE; Pen; PIR; NER; OXC; PRA; Car, Carbamazepine; AMI, Amitriptyline; CLES, Common language effect size; DeGin, Intra-tympanic dexamethasone injection plus ginkgo biloba; 95%CIs, 95% confidence intervals; GRADE, Grading of Recommendations Assessment, Development and Evaluation; ACA, Acamprosate; CLO, Clonazepam; ClD, Clonazepam plus deanxit; RCT, Randomised controlled trials; PRA, Pramipexole; RR, Rate ratio; SMD, Standardized mean difference; KRG, Korean red ginseng; Gab, gabapentin; PAR, Paroxetine; THI, Tinnitus handicap inventory; VAR, Vardenafil; Ozone, Ozone exposure; MeSul, Melatonin and sulodexide; DeLid, Intra-tympanic dexamethasone injection plus lidocaine; GaLid, gabapentin plus intradermal lidocaine injection; SUCRA, Surface under the cumulative ranking curve; DEX, Intra-tympanic dexamethasone injection; ALVitC, Alpha-lipoic acid plus vitamin C; MIS, Misoprostol; Mel, Melatonin alone; Bet, Betahistine; TRI, Postaurical subcutaneous triamcinolone injection; VES, Vestipitant; GABA, gamma-Aminobutyric acid; OXC, Oxcarbazepine; NMA, Network meta-analysis; PaVitE, papaverine hydrochloride plus vitamin E; Met, Intra-tympanic methylprednisolone injection; NER, Neramexane; PIR, Piribedil; Gin, ginkgo biloba; ALP, Alprazolam; CHL, Chlorpheniramine; Zinc, Zinc supplementation; VAS, Visual analogue scale; DeMel, Intra-tympanic dexamethasone injection plus melatonin; TRA, Trazodone; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; VePar, Vestipitant and paroxetine; Pen, Pentoxifylline; SER, Sertraline; PLA, placebo; NOR, Nortriptyline
• ISSN: 2589-5370; 2589-5370
• DOI: 10.1016/j.eclinm.2021.101080

Although tinnitus has a prevalence between 20 and 42.8%, the currently recommended management for tinnitus, such as tinnitus support and psychologic therapies, are relatively time-consuming and expensive. Several new pharmacologic treatments designed for tinnitus patients without specific origin had been developed but their efficacy remains unclear. The current Network Meta-Analysis (NMA) of randomised controlled trials (RCTs) was conducted to evaluate the efficacy of different pharmacologic treatments for tinnitus management in tinnitus patients without specific or treatable origin (i.e. primary tinnitus). Databases were searched from inception to April 5th, 2021. All network meta-analytic procedures were conducted under the frequentist model. We calculated the effect size of outcomes with different rating scales with standardized mean difference. PROSPERO registration: CRD42020177742. Overall, 36 RCTs were included with 2,761 participants. The main results revealed that pharmacologic interventions with brain-acting effect (for example, amitriptyline, acamprosate, and gabapentin) and those with anti-inflammation/anti-oxidant effect (for example, intra-tympanic dexamethasone injection plus oral melatonin) were associated with superior improvement in tinnitus severity and response rate compared to placebo/control. Oral amitriptyline were associated with the highest improvement in tinnitus severity and the fourth highest response rate. None of the investigated interventions was associated with different changes in quality of life compared to placebo/control. All the investigated treatments were associated with similar drop-out rate to placebo/control. The current NMA suggests a potential role for treatments with brain-acting effect (for example, amitriptyline, acamprosate, and gabapentin) or anti-inflammation/anti-oxidant effect (for example, intra-tympanic dexamethasone injection plus oral melatonin) as the preferable effective treatments for tinnitus without specific or treatable origin. none.