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. 2018 Mar 15;2018(3):CD011481. doi: 10.1002/14651858.CD011481.pub2

Garfinkel 1999.

Methods Study design: Randomised controlled trial
Study grouping: Parallel group
Blinding: Double
Duration: 6 weeks double‐blind, 6 weeks single‐blind
Single‐centre
Participants Baseline characteristics
Controlled‐release melatonin
  • Male, N (%): 4 (22)

  • Age, mean (SD): 69 (11)

  • Number of benzodiazepine tablets, mean (SD): 1.08 (0.38)


Placebo
  • Male, N (%): 5 (31)

  • Age, mean (SD): 68 (16)

  • Number of benzodiazepine tablets, mean (SD): 1.23 (0.61)


Inclusion criteria: People with a daily use of benzodiazepines for more than 6 months, expressed willingness to discontinue the use, living independently
Exclusion criteria: Cognitive impairment, liver or renal disorders
Pretreatment: No significant differences
Interventions Intervention characteristics
Benzodiazepine taper schedule: participants were encouraged to reduce their usual benzodiazepine therapy dosage 50% during week 2, 75% during weeks 3 and 4, and then to discontinue benzodiazepine therapy completely during weeks 5 and 6. Participants who did not succeed in stopping benzodiazepine therapy during period 1 were encouraged to further reduce benzodiazepine dosage 50%, 75%, and 100% during weeks 8, 9 and 10, 11 and 12, respectively.
  1. Benzodiazepine taper schedule + controlled‐release melatonin 2 mg/d (2 hours before bedtime)(N = 18)

  2. Benzodiazepine taper schedule + placebo(N = 16)

Outcomes
  • Benzodiazepine cessation

  • Sleep quality (scale 1 to 10, higher = better)

Identification Sponsorship source: Neurim Pharmaceuticals sponsored study medication and study nurse; statistical evaluations performed independently.
Country: Israel
Setting: Outpatients, living independently
Declarations of interest: Not mentioned
Authors name: Doron Garfinkel
Institution: Department of Neurobiochemistry, Tel Aviv University
Email: Navazis@ccsg.tau.ac.il
Address: Tel Aviv 69978, Israel
Notes  
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Comment: Not described
Allocation concealment (selection bias) Unclear risk Comment: Not described
Blinding of participants and personnel (performance bias) 
 All outcomes Low risk Quote: "Subjects were randomised to receive either 2 mg of CRM therapy or a placebo that was identical in appearance"
Blinding of outcome assessment (detection bias) 
 All outcomes Low risk Quote: "Collection and entry of all data were completed before revealing the randomisation codes of the study"
Incomplete outcome data (attrition bias) 
 All outcomes Low risk Comment: All included participants analysed.
Selective reporting (reporting bias) Low risk Comment: No indications of selective reporting
Other bias High risk Comment: The trial was partly financed by a company with an interest in given result, the company's role in interpreting the data is not sufficiently described.