Different doses of dual orexin receptor antagonists in primary insomnia: a Bayesian network analysis
Background: Systematic comparisons of the doses of the Food and Drug Administration (FDA)-approved dual orexin receptor antagonists (DORAs) for people with insomnia are limited.Methods: PubMed, Embase, Cochrane Library, and Clinicaltrials. gov were systematically searched to identify relevant studie...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-05-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2023.1175372/full |
| _version_ | 1827946870266134528 |
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| author | Tao Xue Xin Wu Xin Wu Jiaxuan Li Shujun Chen Zilan Wang Xin Tan Zhong Wang Jianguo Zhang Jianguo Zhang Jianguo Zhang |
| author_facet | Tao Xue Xin Wu Xin Wu Jiaxuan Li Shujun Chen Zilan Wang Xin Tan Zhong Wang Jianguo Zhang Jianguo Zhang Jianguo Zhang |
| author_sort | Tao Xue |
| collection | DOAJ |
| description | Background: Systematic comparisons of the doses of the Food and Drug Administration (FDA)-approved dual orexin receptor antagonists (DORAs) for people with insomnia are limited.Methods: PubMed, Embase, Cochrane Library, and Clinicaltrials. gov were systematically searched to identify relevant studies published before 31 October 2022. We assessed the certainty of evidence using the confidence in network meta-analysis (CINeMA) framework.Results: We pooled 7257 participants from 9 randomized controlled trials (RCTs). Moderate to high certainty evidence demonstrated suvorexant (20 and 40 mg) and daridorexant (10 and 50 mg) as the most effective in latency to persistent sleep (LPS) reduction. Lemborexant at 5 and 10 mg was the most effective in subjective sleep onset time (sTSO) reduction. For wake time after sleep onset (WASO), all drugs except daridorexant 5 mg were more effective than placebo. Lemborexant 5 mg was among the best in subjective WASO (sWASO) (moderate to high certainty) and had the highest surface under the curve ranking area (SUCRA) values for sWASO (100%). For total sleep time (TST), suvorexant and daridorexant, except the respective minimum doses, were more effective than placebo, while suvorexant 40 mg and lemborexant 10 mg may have been the most effective for subjective TST (sTST) (low to very low certainty). Suvorexant 40 mg (RR 1.09), suvorexant 80 mg (RR 1.65), and daridorexant 25 mg (RR 1.16) showed a higher safety risk than placebo.Conclusion: Suvorexant 20 mg, lemborexant 5 mg, lemborexant 10 mg, and daridorexant 50 mg represent suitable approaches for insomnia.Clinical Trial Registration:clinicaltrials.gov, PROSPERO (CRD42022362655). |
| first_indexed | 2024-04-09T12:31:00Z |
| format | Article |
| id | doaj.art-13b5162cb9e84f328329ffcf9d233be8 |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-04-09T12:31:00Z |
| publishDate | 2023-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pharmacology |
| spelling | doaj.art-13b5162cb9e84f328329ffcf9d233be82023-05-16T04:33:40ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122023-05-011410.3389/fphar.2023.11753721175372Different doses of dual orexin receptor antagonists in primary insomnia: a Bayesian network analysisTao Xue0Xin Wu1Xin Wu2Jiaxuan Li3Shujun Chen4Zilan Wang5Xin Tan6Zhong Wang7Jianguo Zhang8Jianguo Zhang9Jianguo Zhang10Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, ChinaDepartment of Neurosurgery, Suzhou Ninth People’s Hospital, Suzhou, ChinaDepartment of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, ChinaDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, ChinaDepartment of Neurology, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, ChinaDepartment of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, ChinaDepartment of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurosurgery, Beijing Neurosurgical Institute, Beijing, ChinaBeijing Key Laboratory of Neurostimulation, Beijing, ChinaBackground: Systematic comparisons of the doses of the Food and Drug Administration (FDA)-approved dual orexin receptor antagonists (DORAs) for people with insomnia are limited.Methods: PubMed, Embase, Cochrane Library, and Clinicaltrials. gov were systematically searched to identify relevant studies published before 31 October 2022. We assessed the certainty of evidence using the confidence in network meta-analysis (CINeMA) framework.Results: We pooled 7257 participants from 9 randomized controlled trials (RCTs). Moderate to high certainty evidence demonstrated suvorexant (20 and 40 mg) and daridorexant (10 and 50 mg) as the most effective in latency to persistent sleep (LPS) reduction. Lemborexant at 5 and 10 mg was the most effective in subjective sleep onset time (sTSO) reduction. For wake time after sleep onset (WASO), all drugs except daridorexant 5 mg were more effective than placebo. Lemborexant 5 mg was among the best in subjective WASO (sWASO) (moderate to high certainty) and had the highest surface under the curve ranking area (SUCRA) values for sWASO (100%). For total sleep time (TST), suvorexant and daridorexant, except the respective minimum doses, were more effective than placebo, while suvorexant 40 mg and lemborexant 10 mg may have been the most effective for subjective TST (sTST) (low to very low certainty). Suvorexant 40 mg (RR 1.09), suvorexant 80 mg (RR 1.65), and daridorexant 25 mg (RR 1.16) showed a higher safety risk than placebo.Conclusion: Suvorexant 20 mg, lemborexant 5 mg, lemborexant 10 mg, and daridorexant 50 mg represent suitable approaches for insomnia.Clinical Trial Registration:clinicaltrials.gov, PROSPERO (CRD42022362655).https://www.frontiersin.org/articles/10.3389/fphar.2023.1175372/fullsuvorexantlemborexantdaridorexantnetwork meta-analysisDORAdual orexin receptor antagonist |
| spellingShingle | Tao Xue Xin Wu Xin Wu Jiaxuan Li Shujun Chen Zilan Wang Xin Tan Zhong Wang Jianguo Zhang Jianguo Zhang Jianguo Zhang Different doses of dual orexin receptor antagonists in primary insomnia: a Bayesian network analysis Frontiers in Pharmacology suvorexant lemborexant daridorexant network meta-analysis DORA dual orexin receptor antagonist |
| title | Different doses of dual orexin receptor antagonists in primary insomnia: a Bayesian network analysis |
| title_full | Different doses of dual orexin receptor antagonists in primary insomnia: a Bayesian network analysis |
| title_fullStr | Different doses of dual orexin receptor antagonists in primary insomnia: a Bayesian network analysis |
| title_full_unstemmed | Different doses of dual orexin receptor antagonists in primary insomnia: a Bayesian network analysis |
| title_short | Different doses of dual orexin receptor antagonists in primary insomnia: a Bayesian network analysis |
| title_sort | different doses of dual orexin receptor antagonists in primary insomnia a bayesian network analysis |
| topic | suvorexant lemborexant daridorexant network meta-analysis DORA dual orexin receptor antagonist |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2023.1175372/full |
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