Effectiveness and safety of mexiletine versus placebo in patients with myotonia: a systematic review and meta-analysis

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 dyst...

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Bibliographic Details
Published in:	Neurological sciences Vol. 45; no. 8; pp. 3989 - 4001
Main Authors:	Elettreby, Abdelrahman Mohammed, Elnaga, Ahmed Abdullah Abo, Alsaied, Mohamed Ahmed, Ewis, Dalia Kamal, Sharkawy, Aya Mohammed, Fareed, Rahma, Alderbi, Gehad Magdy
Format:	Journal Article
Language:	English
Published:	Cham Springer International Publishing 01-08-2024 Springer Nature B.V
Subjects:	Clinical trials Humans Medicine Medicine & Public Health Meta-analysis Mexiletine - therapeutic use Myotonia Myotonia - drug therapy Neurology Neuroradiology Neurosurgery Original Article Patients Placebos Psychiatry Randomized Controlled Trials as Topic Systematic review Treatment Outcome Voltage-Gated Sodium Channel Blockers - administration & dosage Voltage-Gated Sodium Channel Blockers - adverse effects Voltage-Gated Sodium Channel Blockers - pharmacology Voltage-Gated Sodium Channel Blockers - therapeutic use Stiffness Non-dystrophic myotonia Dystrophic myotonia Mexiletine
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Summary:	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.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Undefined-3
ISSN:	1590-1874 1590-3478 1590-3478
DOI:	10.1007/s10072-024-07412-z