{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T11:47:35Z","timestamp":1790423255983,"version":"4.1.0"},"reference-count":48,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T00:00:00Z","timestamp":1724630400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Psychiatry Clin Neurosci"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>We aimed to evaluate the comparative efficacy and acceptability of cognitive behavioral therapy for insomnia (CBT\u2010I), pharmacotherapy, and their combination in the long and short terms among adults with chronic insomnia disorder.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched multiple databases to December 27, 2023. We included trials in hypnotic\u2010free adults with chronic insomnia comparing at least two of CBT\u2010I, pharmacotherapy, or their combination. We assessed the confidence in evidence using CINeMA. The primary outcome was long\u2010term remission. Secondary outcomes included all\u2010cause dropout and self\u2010reported sleep continuity measures in the long term, and the same outcomes in the short term. We performed frequentist random\u2010effects network meta\u2010analyses (CRD42024505519).<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>We identified 13 trials including 823 randomized participants (mean age, 47.8\u2009years; 60% women). CBT\u2010I was more beneficial than pharmacotherapy in the long term (median duration, 24\u2009weeks [range, 12 to 48\u2009weeks]; remission odds ratio, 1.82 [95% confidence interval (CI), 1.15\u20132.87]; [certainty of evidence: high]), while there was weaker evidence of benefit of combination against pharmacotherapy (1.71 [95% CI, 0.88\u20133.30: moderate]) and no clear difference of CBT\u2010I against combination (1.07 [95% CI, 0.63\u20131.80: moderate]). CBT\u2010I was associated with fewer dropouts than pharmacotherapy. Short\u2010term outcomes favored CBT\u2010I over pharmacotherapy except total sleep time. Given the average long\u2010term remission rate in the pharmacotherapy\u2010initiating arms of 28%, CBT\u2010I resulted in a long\u2010term remission rate of 41% (95% CI, 31%\u201353%) and combination 40% (95% CI, 25%\u201356%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>The current study found that starting with CBT\u2010I for chronic insomnia leads to better outcomes than pharmacotherapy. Combination may be better than pharmacotherapy alone, but unlikely to be worth the additional burden over CBT\u2010I alone.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pcn.13730","type":"journal-article","created":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T06:30:36Z","timestamp":1724740236000},"page":"646-653","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Initial treatment choices for long\u2010term remission of chronic insomnia disorder in adults: a systematic review and network meta\u2010analysis"],"prefix":"10.1111","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1317-0220","authenticated-orcid":false,"given":"Yuki","family":"Furukawa","sequence":"first","affiliation":[{"name":"Department of Neuropsychiatry University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5358-5263","authenticated-orcid":false,"given":"Masatsugu","family":"Sakata","sequence":"additional","affiliation":[{"name":"Department of Neurodevelopmental Disorders Nagoya City University Graduate School of Medical Sciences  Aichi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2159-3776","authenticated-orcid":false,"given":"Toshiaki A.","family":"Furukawa","sequence":"additional","affiliation":[{"name":"Department of Health Promotion and Human Behavior and of Clinical Epidemiology Kyoto University Graduate School of Medicine \/ School of Public Health  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0955-7572","authenticated-orcid":false,"given":"Orestis","family":"Efthimiou","sequence":"additional","affiliation":[{"name":"Institute of Social and Preventive Medicine (ISPM) University of Bern  Bern Switzerland"},{"name":"Institute of Primary Health Care (BIHAM) University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6806-759X","authenticated-orcid":false,"given":"Michael","family":"Perlis","sequence":"additional","affiliation":[{"name":"Behavioral Sleep Medicine Program, Department of Psychiatry University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Department of Psychiatry and The School of Nursing University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,8,26]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2010.10.023"},{"key":"e_1_2_10_3_1","doi-asserted-by":"crossref","unstructured":"ReubenC ElgaddalN BlackL.Data Brief 462: Sleep medication use in adults aged 18 and over: United States.2020.https:\/\/doi.org\/10.15620\/cdc:123013.","DOI":"10.15620\/cdc:123013"},{"key":"e_1_2_10_4_1","unstructured":"Prescription sleep aid use among adults: United States 2005\u20132010. 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