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Comparison of the Therapeutic Efficacy of a Fixed Low-Dose Combination of Cinnarizine and Dimenhydrinate with Betahistine in Vestibular Neuritis

A Randomized, Double-Blind, Non-Inferiority Study

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Abstract

Background: Vestibular neuritis (VN) is a strongly disabling disease of the peripheral vestibular system. Rapid and effective relief of symptoms is important to allow patients to promptly return to normal physical activity.

Objective: The aim of this prospective, randomized, double-blind study was to evaluate the efficacy of a fixed low-dose combination of cinnarizine and dimenhydrinate in unilateral VN in comparison with betahistine in terms of improvement of vertigo and concomitant symptoms, and performance in neurotological testing.

Methods: Sixty-two patients were randomized to receive either cinnarizine 20 mg/dimenhydrinate 40 mg as a fixed combination or betahistine 12mg, each three times daily for 4 weeks. Vertigo and concomitant symptoms, activities of daily living (ADL), posturography and a battery of vestibulo-ocular tests, registered by electronystagmography including spontaneous nystagmus, bithermal caloric and rotatory test, among others, were assessed at baseline (t0), after 1 week (t1w) and after 4 weeks (t4w). The primary endpoint was the Mean Vertigo Score (MVS) at t1w, a composite of 12 individual scores for unprovoked and provoked vertigo, each assessed using a 10 cm visual analogue scale (VAS). Non-inferiority of the fixed combination versus betahistine would be assumed if the two-sided 95% confidence intervals (CIs) for between-group differences in MVS lay entirely below the non-inferiority margin of 1.25 (12.5% of VAS range).

Results: The fixed combination led to significantly greater improvements in MVS than betahistine both at t1w (primary endpoint) and at t4w (95% CI for the difference in baseline-adjusted means −0.95, −0.64 at t1w, −0.77, −0.44 at t4w; p < 0.001). Vegetative symptoms and ADL also improved significantly more under the fixed combination than under betahistine at t1w (p< 0.001, each parameter) and t4w (p<0.001 and p<0.01, respectively), both showing a nearly complete remission at t4w. In the two groups, pathological posturo-graphy and electronystagmography parameters normalized during the 4-week treatment. The fixed combination group showed an earlier recovery of spontaneous nystagmus than the betahistine group (t1w, p < 0.001) and slightly higher improvements in asymmetry of rotation-induced nystagmus at t1w and t4w (p = 0.041, each time point). No significant differences were found between the treatments in abatement of spontaneous nystagmus at t4w and decrease of caloric lateralization or improvement of equilibrium (sensory organization test [SOT], conditions 5/6) at t1w and t4w. No patient reported any adverse event.

Conclusion: The results showed that the fixed low-dose combination of cin-narizine and dimenhydrinate is an effective and well tolerated option for symptomatic treatment in unilateral VN. The fixed combination led to significant improvements in vertigo and ADL within the first week, and to a nearly complete recovery after 4 weeks. Neurotological testing revealed no signs of a possible detrimental influence of the 4-week treatment with the fixed combination compared with betahistine in terms of recovery of caloric responsiveness and abatement of rotation-induced nystagmus.

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Acknowledgements

The conduct, statistical analysis and publication of this study were funded by Hennig Arzneimittel, Floersheim am Main, Germany. Coauthors N. Burchardi, I. Bognar-Steinberg and W. Baumann are employees of the study sponsor. A-W. Scholtz and R. Steindl are employees of University of Innsbruck and have no potential conflicts of interest.

Preliminary data from this study were presented at the 8. Hennig-Symposium ‘Vertigo-Controverse and Proven Issues’, Erlangen/Nürnberg, Germany, October 2010.[27]

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Correspondence to Irene Bognar-Steinberg.

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Scholtz, AW., Steindl, R., Burchardi, N. et al. Comparison of the Therapeutic Efficacy of a Fixed Low-Dose Combination of Cinnarizine and Dimenhydrinate with Betahistine in Vestibular Neuritis. Clin Drug Investig 32, 387–399 (2012). https://doi.org/10.2165/11632410-000000000-00000

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