MedicalResearch.com Interview with:
Kuan-Pin Su, MD, PhD
China Medical University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Delirium, also known as acute confusional state, is a serious disturbance in mental abilities that results in confused thinking and reduced awareness of the environment. Delirium can often be traced to one or more contributing factors, such as a severe or chronic illness, changes in metabolic balance (such as low sodium), medication, infection, surgery, or alcohol or drug intoxication or withdrawal. It’s critically important to identify and treat delirium because some of the contributing factors could be life-threatening. However, there is no sufficient evidence for choice of medication to treat or prevent the symptoms of delirium.
A recent paper, Association of Delirium Response and Safety of Pharmacological Interventions for the Management and Prevention of Delirium A Network Meta-analysis, published in JAMA Psychiatry provides important findings of this missing piece in that important clinical uncertainty. The leading author, Professor Kuan-Pin Su, at the China Medical University in Taichung, Taiwan, concludes the main finding about treatment/prevention of delirium: “In this report, we found that the combination of haloperidol and lorazepam demonstrated the best option for treatment of delirium, while ramelteon for prevention against delirium.
MedicalResearch.com: What should readers take away from your report?
Response: In addition to the superiority of “haloperidol plus lorazepam” and “ramelteon” in treatment and prevention to delirium, the paper also revealed an important result that both of these regimens did not associate with higher all-cause mortality rate than placebo/control did. That is, the safety of such regimen was similar with that of placebo/control, in aspect of risk of mortality.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: In the result of the current network meta-analysis, it was not surprising the superiority of “haloperidol plus lorazepam” in treatment to delirium. However, the superiority of “ramelteon” in prevention to delirium worth further discussion. According to another main author, Dr Ping-Tao Tseng from the WinShine Clinics in Kaohsiung, Taiwan, “the disruptive circadian rhythm could be a major cause, while at the same time, consequence of delirium. Based upon this rationale, the correction of such abnormality might be one potential prevention strategy to delirium.” However, there lack of conclusive evidences to prove such a hypothesis. Future well-designed trials should be warranted to prove or refute this hypothesis.
MedicalResearch.com: Is there anything else you would like to add?
Response: Another main author, Dr Yi-Cheng Wu, from the Chang Gung Memorial Hospital in Linkou, Taiwan, added, “single randomized controlled trial or traditional pairwise meta-analysis provides less information than network meta-analysis to synthesize direct and indirect evidence for decision-making. Network meta-analysis might produce stronger evidence than pairwise meta-analysis did.” Finally, we want to reaffirm that the clinicians should, when the delirium occurred, pay more attention to survey and correct patients’ underlying diseases rather than simply prescribing medication for the set of delirium symptoms.
Wu Y, Tseng P, Tu Y, et al. Association of Delirium Response and Safety of Pharmacological Interventions for the Management and Prevention of Delirium: A Network Meta-analysis. JAMA Psychiatry. Published online February 27, 2019. doi:10.1001/jamapsychiatry.2018.4365
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