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Effectiveness and safety of mexiletine versus placebo in patients with myotonia: a systematic review and meta-analysis
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Effectiveness and safety of mexiletine versus placebo in patients with myotonia: a systematic review and meta-analysis
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Effectiveness and safety of mexiletine versus placebo in patients with myotonia: a systematic review and meta-analysis
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Journal Article
Effectiveness and safety of mexiletine versus placebo in patients with myotonia: a systematic review and meta-analysis
2024
Overview
Background
The rare nature of dystrophic and non-dystrophic myotonia has limited the available evidence on the efficacy of mexiletine as a potential treatment. To address this gap, we conducted a systematic review and meta-analysis to evaluate the effectiveness and safety of mexiletine for both dystrophic and non-dystrophic myotonic patients.
Methods
The search was conducted on various electronic databases up to March 2023, for randomized clinical trials (RCTs) comparing mexiletine versus placebo in myotonic patients. A risk of bias assessment was carried out, and relevant data was extracted manually into an online sheet. RevMan software (version 5.4) was employed for analysis.
Results
A total of five studies, comprising 186 patients, were included in the meta-analysis. Our findings showed that mexiletine was significantly more effective than placebo in improving stiffness score (SMD = − 1.19, 95% CI [− 1.53, − 0.85]), as well as in reducing hand grip myotonia (MD = − 1.36 s, 95% CI [− 1.83, − 0.89]). Mexiletine also significantly improved SF-36 Physical and Mental Component Score in patients with non-dystrophic myotonia only. Regarding safety, mexiletine did not significantly alter ECG parameters but was associated with greater gastrointestinal symptoms (GIT) compared to placebo (RR 3.7, 95% CI [1.79, 7.64]). Other adverse events showed no significant differences.
Conclusion
The results support that mexiletine is effective and safe in myotonic patients; however, it is associated with a higher risk of GIT symptoms. Due to the scarcity of published RCTs and the prevalence of GIT symptoms, we recommend further well-designed RCTs testing various drug combinations to reduce GIT symptoms.
Publisher
Springer International Publishing,Springer Nature B.V
Subject
/ Humans
/ Medicine
/ Mexiletine - therapeutic use
/ Myotonia
/ Patients
/ Placebos
/ Randomized Controlled Trials as Topic
/ Voltage-Gated Sodium Channel Blockers - administration & dosage
/ Voltage-Gated Sodium Channel Blockers - adverse effects
