Gary Zammit1, Yves Dauvilliers1, Scott Pain2, Dalma Sebök Kinter2, Yosef Mansour2, Dieter Kunz2. 1. From the Clinilabs Drug Development Corporation (G.Z.); Icahn School of Medicine at Mount Sinai (G.Z.), New York, NY; Unité du Sommeil (Y.D.), Département de Neurologie, Hôpital Gui-de-Chauliac, Université Montpellier, INSERM 1061, Montpellier, France; Idorsia Pharmaceuticals Ltd (S.P., D.S.K., Y.M.), Allschwil, Switzerland; and Intellux Berlin GmbH (D.K.), Germany. gzammit@clinilabs.com ydauvilliers@yahoo.fr. 2. From the Clinilabs Drug Development Corporation (G.Z.); Icahn School of Medicine at Mount Sinai (G.Z.), New York, NY; Unité du Sommeil (Y.D.), Département de Neurologie, Hôpital Gui-de-Chauliac, Université Montpellier, INSERM 1061, Montpellier, France; Idorsia Pharmaceuticals Ltd (S.P., D.S.K., Y.M.), Allschwil, Switzerland; and Intellux Berlin GmbH (D.K.), Germany.
Abstract
OBJECTIVE: To assess the dose-response of daridorexant, a new dual orexin receptor antagonist, on wake after sleep onset (WASO). METHODS:Elderly (≥65 years) participants (n = 58) with insomnia were randomly allocated (Latin square design) to receive 5 treatments (5, 10, 25, and 50 mg daridorexant and placebo) during 5 treatment periods, each consisting of 2 treatment nights followed by a 5- to 12-day washout period. Main efficacy endpoints were the absolute change from baseline in WASO (primary) and latency to persistent sleep (LPS; secondary) to days 1 and 2 (mean of 2 treatment nights assessed by polysomnography) in each period. Safety and tolerability were also assessed. RESULTS:Of 58 participants included, 67% were female, and the median age was 69 years (range 65-85 years). WASO and LPS were dose-dependently reduced from baseline to days 1 and 2 after daridorexant administration (multiple comparison procedure modeling, p < 0.0001 and p = 0.004, respectively); reductions were statistically significant for doses ≥10 mg compared with placebo (WASO: -32.0, -45.1, -61.4 minutes; LPS: -44.9, -43.8, -45.4 minutes for 10, 25, and 50 mg, respectively, p ≤ 0.025). Treatment-emergent adverse events were similar for daridorexant and placebo; the most frequent were fatigue, nasopharyngitis, gait disturbance, and headache (≤7% in any group). CONCLUSIONS:Daridorexant was well tolerated. Dose-dependent improvements in WASO and LPS were statistically significant (dose range 10-50 mg) in elderly people with insomnia disorder. CLINICALTRIALSGOV IDENTIFIER: NCT02841709. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that, for elderly people with insomnia, daridorexant reduced WASO.
RCT Entities:
OBJECTIVE: To assess the dose-response of daridorexant, a new dual orexin receptor antagonist, on wake after sleep onset (WASO). METHODS: Elderly (≥65 years) participants (n = 58) with insomnia were randomly allocated (Latin square design) to receive 5 treatments (5, 10, 25, and 50 mg daridorexant and placebo) during 5 treatment periods, each consisting of 2 treatment nights followed by a 5- to 12-day washout period. Main efficacy endpoints were the absolute change from baseline in WASO (primary) and latency to persistent sleep (LPS; secondary) to days 1 and 2 (mean of 2 treatment nights assessed by polysomnography) in each period. Safety and tolerability were also assessed. RESULTS: Of 58 participants included, 67% were female, and the median age was 69 years (range 65-85 years). WASO and LPS were dose-dependently reduced from baseline to days 1 and 2 after daridorexant administration (multiple comparison procedure modeling, p < 0.0001 and p = 0.004, respectively); reductions were statistically significant for doses ≥10 mg compared with placebo (WASO: -32.0, -45.1, -61.4 minutes; LPS: -44.9, -43.8, -45.4 minutes for 10, 25, and 50 mg, respectively, p ≤ 0.025). Treatment-emergent adverse events were similar for daridorexant and placebo; the most frequent were fatigue, nasopharyngitis, gait disturbance, and headache (≤7% in any group). CONCLUSIONS:Daridorexant was well tolerated. Dose-dependent improvements in WASO and LPS were statistically significant (dose range 10-50 mg) in elderly people with insomnia disorder. CLINICALTRIALSGOV IDENTIFIER: NCT02841709. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that, for elderly people with insomnia, daridorexant reduced WASO.
Authors: Natasha C Dale; Daniel Hoyer; Laura H Jacobson; Kevin D G Pfleger; Elizabeth K M Johnstone Journal: Front Cell Neurosci Date: 2022-04-13 Impact factor: 6.147