Evidence‐based insomnia treatment strategy using novel orexin antagonists: A review
Abstract Most conventional insomnia medications are gamma‐aminobutylic acid receptor agonists. However, physical dependence is a concern and one of the major limiting factors for long‐term treatment. The dual orexin receptor antagonists, suvorexant and lemborexant, were recently approved for treatin...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-12-01
|
| Series: | Neuropsychopharmacology Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/npr2.12205 |
| _version_ | 1811185642100490240 |
|---|---|
| author | Taro Kishi Maika Nishida Michinori Koebis Takehiro Taninaga Kenzo Muramoto Naoki Kubota Margaret Moline Kenji Sakuma Makoto Okuya Ikuo Nomura Nakao Iwata |
| author_facet | Taro Kishi Maika Nishida Michinori Koebis Takehiro Taninaga Kenzo Muramoto Naoki Kubota Margaret Moline Kenji Sakuma Makoto Okuya Ikuo Nomura Nakao Iwata |
| author_sort | Taro Kishi |
| collection | DOAJ |
| description | Abstract Most conventional insomnia medications are gamma‐aminobutylic acid receptor agonists. However, physical dependence is a concern and one of the major limiting factors for long‐term treatment. The dual orexin receptor antagonists, suvorexant and lemborexant, were recently approved for treating chronic insomnia, giving a novel pharmacotherapeutic option. Because there are no comparative studies on these drugs, a network meta‐analysis was conducted, which is suitable for comparing interventions. According to this analysis, 5‐ and 10‐mg lemborexant were superior to 20‐mg suvorexant because of the greater improvement in initiating sleep after 1‐week administration. Furthermore, 5‐mg lemborexant (not 10 mg) and suvorexant were similarly well tolerated, without requiring discontinuation due to adverse events. We also overviewed the pharmacological and pharmacokinetic properties of lemborexant and suvorexant that may support these clinical outcomes. When compared to suvorexant, lemborexant quickly binds to the orexin receptors. The time to reach the maximum concentration after multiple administrations is shorter for lemborexant than for suvorexant. Considering these results, we recommend 5‐mg lemborexant as an initial treatment for insomnia, followed by 10‐mg lemborexant or suvorexant. |
| first_indexed | 2024-04-11T13:33:43Z |
| format | Article |
| id | doaj.art-e1c3cd06cd9f45a8a585f4644d879cd0 |
| institution | Directory Open Access Journal |
| issn | 2574-173X |
| language | English |
| last_indexed | 2024-04-11T13:33:43Z |
| publishDate | 2021-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Neuropsychopharmacology Reports |
| spelling | doaj.art-e1c3cd06cd9f45a8a585f4644d879cd02022-12-22T04:21:43ZengWileyNeuropsychopharmacology Reports2574-173X2021-12-0141445045810.1002/npr2.12205Evidence‐based insomnia treatment strategy using novel orexin antagonists: A reviewTaro Kishi0Maika Nishida1Michinori Koebis2Takehiro Taninaga3Kenzo Muramoto4Naoki Kubota5Margaret Moline6Kenji Sakuma7Makoto Okuya8Ikuo Nomura9Nakao Iwata10Department of Psychiatry Fujita Health University School of Medicine Toyoake Aichi JapanEisai Co., Ltd. Tokyo JapanEisai Co., Ltd. Tokyo JapanEisai Co., Ltd. Tokyo JapanEisai Co., Ltd. Tokyo JapanEisai Co., Ltd. Tokyo JapanEisai Inc. Woodcliff Lake New Jersey USADepartment of Psychiatry Fujita Health University School of Medicine Toyoake Aichi JapanDepartment of Psychiatry Fujita Health University School of Medicine Toyoake Aichi JapanDepartment of Psychiatry Fujita Health University School of Medicine Toyoake Aichi JapanDepartment of Psychiatry Fujita Health University School of Medicine Toyoake Aichi JapanAbstract Most conventional insomnia medications are gamma‐aminobutylic acid receptor agonists. However, physical dependence is a concern and one of the major limiting factors for long‐term treatment. The dual orexin receptor antagonists, suvorexant and lemborexant, were recently approved for treating chronic insomnia, giving a novel pharmacotherapeutic option. Because there are no comparative studies on these drugs, a network meta‐analysis was conducted, which is suitable for comparing interventions. According to this analysis, 5‐ and 10‐mg lemborexant were superior to 20‐mg suvorexant because of the greater improvement in initiating sleep after 1‐week administration. Furthermore, 5‐mg lemborexant (not 10 mg) and suvorexant were similarly well tolerated, without requiring discontinuation due to adverse events. We also overviewed the pharmacological and pharmacokinetic properties of lemborexant and suvorexant that may support these clinical outcomes. When compared to suvorexant, lemborexant quickly binds to the orexin receptors. The time to reach the maximum concentration after multiple administrations is shorter for lemborexant than for suvorexant. Considering these results, we recommend 5‐mg lemborexant as an initial treatment for insomnia, followed by 10‐mg lemborexant or suvorexant.https://doi.org/10.1002/npr2.12205evidence‐based medicineinsomnialemborexantnetwork meta‐analysisorexin |
| spellingShingle | Taro Kishi Maika Nishida Michinori Koebis Takehiro Taninaga Kenzo Muramoto Naoki Kubota Margaret Moline Kenji Sakuma Makoto Okuya Ikuo Nomura Nakao Iwata Evidence‐based insomnia treatment strategy using novel orexin antagonists: A review Neuropsychopharmacology Reports evidence‐based medicine insomnia lemborexant network meta‐analysis orexin |
| title | Evidence‐based insomnia treatment strategy using novel orexin antagonists: A review |
| title_full | Evidence‐based insomnia treatment strategy using novel orexin antagonists: A review |
| title_fullStr | Evidence‐based insomnia treatment strategy using novel orexin antagonists: A review |
| title_full_unstemmed | Evidence‐based insomnia treatment strategy using novel orexin antagonists: A review |
| title_short | Evidence‐based insomnia treatment strategy using novel orexin antagonists: A review |
| title_sort | evidence based insomnia treatment strategy using novel orexin antagonists a review |
| topic | evidence‐based medicine insomnia lemborexant network meta‐analysis orexin |
| url | https://doi.org/10.1002/npr2.12205 |
| work_keys_str_mv | AT tarokishi evidencebasedinsomniatreatmentstrategyusingnovelorexinantagonistsareview AT maikanishida evidencebasedinsomniatreatmentstrategyusingnovelorexinantagonistsareview AT michinorikoebis evidencebasedinsomniatreatmentstrategyusingnovelorexinantagonistsareview AT takehirotaninaga evidencebasedinsomniatreatmentstrategyusingnovelorexinantagonistsareview AT kenzomuramoto evidencebasedinsomniatreatmentstrategyusingnovelorexinantagonistsareview AT naokikubota evidencebasedinsomniatreatmentstrategyusingnovelorexinantagonistsareview AT margaretmoline evidencebasedinsomniatreatmentstrategyusingnovelorexinantagonistsareview AT kenjisakuma evidencebasedinsomniatreatmentstrategyusingnovelorexinantagonistsareview AT makotookuya evidencebasedinsomniatreatmentstrategyusingnovelorexinantagonistsareview AT ikuonomura evidencebasedinsomniatreatmentstrategyusingnovelorexinantagonistsareview AT nakaoiwata evidencebasedinsomniatreatmentstrategyusingnovelorexinantagonistsareview |