Quality of melatonin use in children and adolescents: findings from a UK clinical audit.
child & adolescent psychiatry
sleep
Journal
BMJ mental health
ISSN: 2755-9734
Titre abrégé: BMJ Ment Health
Pays: England
ID NLM: 9918521385306676
Informations de publication
Date de publication:
22 Jan 2024
22 Jan 2024
Historique:
received:
29
09
2023
accepted:
19
11
2023
medline:
2
8
2024
pubmed:
2
8
2024
entrez:
2
8
2024
Statut:
epublish
Résumé
Melatonin is commonly used to treat sleep disturbance in children and adolescents, although uncertainties about its optimal use remain. To determine to what extent prescribing of melatonin complies with evidence-based clinical practice standards. As part of a quality improvement programme, the Prescribing Observatory for Mental Health conducted a retrospective clinical audit in UK services for children and adolescents. Data were submitted for 4151 children and adolescents up to 18 years of age, treated with melatonin: 3053 (74%) had a diagnosis of neurodevelopmental disorder. In 2655 (73%) of the 3651 patients prescribed melatonin to be taken regularly, the main reason was to reduce sleep latency (time taken to fall asleep). In 409 patients recently starting melatonin, a non-pharmacological intervention had already been tried in 279 (68%). The therapeutic response of patients early in treatment (n=899) and on long-term treatment (n=2353) had been assessed and quantified in 36% and 31%, respectively, while for review of side effects, the respective proportions were 46% and 43%. Planned treatment breaks were documented in 317 (13%) of those on long-term treatment. Melatonin was predominantly prescribed for evidence-based clinical indications, but the clinical review and monitoring of this treatment fell short of best practice. With limited methodical review of melatonin use in their patients, clinicians will fail to garner reliable information on its risks and benefits for individual patients. The lack of such practice-based evidence may increase the risk of melatonin being inappropriately targeted or continued despite being ineffective or no longer indicated.
Sections du résumé
BACKGROUND
BACKGROUND
Melatonin is commonly used to treat sleep disturbance in children and adolescents, although uncertainties about its optimal use remain.
OBJECTIVE
OBJECTIVE
To determine to what extent prescribing of melatonin complies with evidence-based clinical practice standards.
METHODS
METHODS
As part of a quality improvement programme, the Prescribing Observatory for Mental Health conducted a retrospective clinical audit in UK services for children and adolescents.
FINDINGS
RESULTS
Data were submitted for 4151 children and adolescents up to 18 years of age, treated with melatonin: 3053 (74%) had a diagnosis of neurodevelopmental disorder. In 2655 (73%) of the 3651 patients prescribed melatonin to be taken regularly, the main reason was to reduce sleep latency (time taken to fall asleep). In 409 patients recently starting melatonin, a non-pharmacological intervention had already been tried in 279 (68%). The therapeutic response of patients early in treatment (n=899) and on long-term treatment (n=2353) had been assessed and quantified in 36% and 31%, respectively, while for review of side effects, the respective proportions were 46% and 43%. Planned treatment breaks were documented in 317 (13%) of those on long-term treatment.
CONCLUSIONS
CONCLUSIONS
Melatonin was predominantly prescribed for evidence-based clinical indications, but the clinical review and monitoring of this treatment fell short of best practice.
CLINICAL IMPLICATIONS
CONCLUSIONS
With limited methodical review of melatonin use in their patients, clinicians will fail to garner reliable information on its risks and benefits for individual patients. The lack of such practice-based evidence may increase the risk of melatonin being inappropriately targeted or continued despite being ineffective or no longer indicated.
Identifiants
pubmed: 39093720
pii: bmjment-2023-300894
doi: 10.1136/bmjment-2023-300894
pii:
doi:
Substances chimiques
Melatonin
JL5DK93RCL
Central Nervous System Depressants
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: CP, OR, AR, GB and TREB have no interests to declare. PG was CI on the NIHR investigator-led Mends RCT melatonin trial and the Neurim industry-led international RCT for Slenyto melatonin; reports participation in advisory panels for AGB, Flynn Pharma and Alturix; but reports no shares or ongoing work with any of the above. AL reports speaking and travel honoraria from Takeda and Flynn Pharma.