Systemic pharmacological interventions for Ménière's disease

• Published in: Cochrane database of systematic reviews 2023-02, Vol.2 (2), p.CD015171-CD015171
• Main Authors: Webster, Katie E, Galbraith, Kevin, Harrington-Benton, Natasha A, Judd, Owen, Kaski, Diego, Maarsingh, Otto R, MacKeith, Samuel, Ray, Jaydip, Van Vugt, Vincent A, Burton, Martin J
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones; Adult; Betahistine; Diuretics; Histamine Antagonists; Humans; Meniere Disease - therapy; Non-malignant disease; Tinnitus; Vertigo
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD015171.pub2

Ménière's disease is a condition that causes recurrent episodes of vertigo, associated with hearing loss and tinnitus. A number of pharmacological interventions have been used in the management of this condition, including betahistine, diuretics, antiviral medications and corticosteroids. The underlying cause of Ménière's disease is unknown, as is the way in which these treatments may work. The efficacy of these different interventions at preventing vertigo attacks, and their associated symptoms, is currently unclear. To evaluate the benefits and harms of systemic pharmacological interventions versus placebo or no treatment in people with Ménière's disease. The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 14 September 2022. We included randomised controlled trials (RCTs) and quasi-RCTs in adults with definite or probable Ménière's disease comparing betahistine, diuretics, antihistamines, antivirals or systemic corticosteroids with either placebo or no treatment. We excluded studies with follow-up of less than three months, or with a cross-over design (unless data from the first phase of the study could be identified).  DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were: 1) improvement in vertigo (assessed as a dichotomous outcome - improved or not improved), 2) change in vertigo (assessed as a continuous outcome, with a score on a numerical scale) and 3) serious adverse events. Our secondary outcomes were: 4) disease-specific health-related quality of life, 5) change in hearing, 6) change in tinnitus and 7) other adverse effects. We considered outcomes reported at three time points: 3 to < 6 months, 6 to ≤ 12 months and > 12 months. We used GRADE to assess the certainty of evidence for each outcome.  MAIN RESULTS: We included 10 studies with a total of 848 participants. The studies evaluated the following interventions: betahistine, diuretics, antivirals and corticosteroids. We did not identify any evidence on antihistamines.  Betahistine Seven RCTs (548 participants) addressed this comparison. However, we were unable to conduct any meta-analyses for our primary outcomes as not all outcomes were considered by every study, and studies that did report the same outcome used different time po