Single-dose antihistamines more effective at decreasing acute vertigo severity within 2 hours than single-dose benzodiazepines

Référence

Hunter BR, Wang AZ, Bucca AW, et al. Efficacy of benzodiazepines or antihistamines for patients with acute vertigo: a systematic review and meta-analysis. JAMA Neurol 2022;79(9):846-855.

Sommaire

These authors searched several databases, the bibliographies of included studies and review papers, and ClinicalTrials.gov to identify randomized or quasi-randomized trials that evaluated drugs for the management of patients with acute vertigo (duration of 2 weeks or less). They were interested in symptom improvement at 2 hours, 1 week, and 1 month after treatment. Although they found 27 trials, only 17 (with 1586 participants) reported data on the outcomes of interest. Most of the studies enrolled patients with generalized or nonspecific “peripheral” vertigo; 4 enrolled patients with benign paroxysmal positional vertigo (BPPV). The studies evaluated 2 benzodiazepines (lorazepam and diazepam) and a variety of antihistamines, each variably compared with placebo, no treatment, another active agent, or, in the case of BPPV, Epley maneuvers. Of the 8 trials reporting 2-hour outcomes, 5 were low risk of bias. Of the 9 trials reporting 1-week and 1-month outcomes, all had a high risk of bias. All the studies assessing 2-hour outcomes compared antihistamines with other medications. Three trials with low risk of bias reported that antihistamines were more effective at decreasing vertigo severity than benzodiazepines (16.1/100 on a visual analog scale), but with moderate heterogeneity (I2 = 47%). After pooling all the data, antihistamines were no better than other therapies, but the authors found high heterogeneity (I2 = 84%). The authors found no significant differences for treatments at 1 week or at 1 month. In the studies evaluating patients with BPPV, 1 week later and again 1 month later, antihistamines were no better than Epley maneuvers in decreasing vertigo severity nor in resolution. Overall, none of the medications were effective in decreasing nausea severity or the need for rescue therapy. Finally, the authors note that the studies inconsistently reported adverse events and that, other than 2 patients needing bag-valve-mask treatment for benzodiazepine-induced hypoventilation (I hate when that happens), the adverse events were mild.