Efficacy and safety of lemborexant over 12 months in Asian adults with insomnia disorder

Efficacy and safety of Lemborexant in treating adult patients with insomnia in China: a single-center, retrospective observational study

Background

Except for one case report, there has been no published study of Lemborexant treatment for patients with insomnia in China. This study investigated efficacy and safety of Lemborexant in treating Chinese patients with insomnia.

Methods

In this single-center, retrospective observational study, adult patients diagnosed with insomnia with an Insomnia Severity Index (ISI) score of ≥8 who were prescribed Lemborexant at Guangzhou United Family Hospital from January 2023 to July 2024 and who had ≥2 follow-up ISI assessment(s) were included. The primary outcome was change in the ISI total score from baseline after 4 weeks of Lemborexant treatment. Treatment-emergent adverse events (TEAEs) were collected.

Results

Forty patients with a mean baseline ISI score of 17.0 ± 3.3 were included. The treatment continuation rate during the median 8-week (range: 2-20) follow-up was 90%. The ISI total score was reduced significantly from baseline after 4 weeks of treatment (-10.2 ± 3.0, p < 0.001), and was further reduced after 8 weeks of treatment (-12.7 ± 3.7, p < 0.001). Significant improvement in ISI total score at week 8 over week 4 was also observed. Both the Patient Health Questionnaire-9 and the General Anxiety Disorder-7 scores improved significantly after 4 weeks and 8 weeks of treatment. Thirty five (87.5%) patients were Lemborexant responders (ISI < 8). Age, combination therapy and Lemborexant 10 mg qn were independent factors associated with Lemborexant responders. One (2.5%) patient experienced mild dizziness. No patient discontinued the treatment due to TEAE(s).

Conclusion

Lemborexant treatment was effective and safe in treating a wide variety of Chinese patients with different symptom(s) of insomnia.

Efficacy and safety of lemborexant in subjects with insomnia disorder receiving medications for depression or anxiety symptoms

AIM

Individuals with insomnia frequently have comorbid depression or anxiety. This study sought to provide a preliminary indication of the effects of lemborexant (LEM) in subjects treated for mild depression/anxiety symptoms.

METHODS

E2006-G000-303 (NCT02952820; EudraCT 2015-001463-39; SUNRISE-2) was a 12-month, phase 3, randomized, placebo-controlled, double-blind study where subjects with insomnia disorder were randomized (1:1:1) to placebo, LEM 5 mg (LEM5), or LEM 10 mg (LEM10) for 6 months. During the second 6 months (not reported), placebo-treated subjects were re-randomized to LEM5 or LEM10. In this post hoc analysis, changes from baseline (CFB) in subject-reported (subjective) sleep onset latency (sSOL), sleep efficiency (sSE), wake after sleep onset (sWASO), total sleep time (sTST), Fatigue Severity Scale, and Insomnia Severity Index were evaluated in subjects treated with medications for symptoms of depression/anxiety (subpopulation).

RESULTS

Of 949 randomized subjects, 61 treated with medications for symptoms of depression/anxiety were included. In the subpopulation, CFB comparing LEM with placebo were generally smaller than the overall population due to a larger placebo response in the subpopulation. However, the magnitudes of CFB within the active treatment groups for sSOL, sWASO, sTST, and sSE were similar between the subpopulation and the overall population. No new safety signals were observed in the subpopulation.

CONCLUSION

LEM treatment benefited subjects with insomnia treated with medications for depression/anxiety symptoms, with no new safety signals. A greater placebo response in the subpopulation than in the overall population decreased the drug versus placebo effect size for LEM, as has been reported for other insomnia medications.

Lemborexant for the Treatment of Insomnia in Patients From China: Four Case Studies

Lemborexant is a competitive antagonist of dual orexin receptors indicated for the treatment of adult patients with insomnia characterized by difficulties with sleep onset and/or sleep maintenance that occur at least three nights per week for ≥3 months, although there is adequate opportunity for sleep. There has been no published study of its efficacy and safety in treating patients from China with insomnia. In this case report, we present four adult patients from China with insomnia who were successfully treated with add-on lemborexant or switched from benzodiazepines or Z-drugs to lemborexant. None of the four patients experienced any discomforts related to lemborexant use. In conclusion, lemborexant treatment was effective and safe in treating the four patients from China with insomnia in this case report, and more studies are warranted to further assess the efficacy and safety of lemborexant in treating patients from China with insomnia.

2023 Guidelines on the Diagnosis and Treatment of Insomnia in Adults - Brazilian Sleep Association

Chronic insomnia disorder (simplified in this document as insomnia) is an increasingly common clinical condition in society and a frequent complaint at the offices of different areas of health practice (particularly Medicine and Psychology). This scenario has been accompanied by a significant evolution in treatment, as well as challenges in approaching patients in an appropriately way. This clinical guideline, coordinated by the Brazilian Sleep Association and the Brazilian Association of Sleep Medicine and counting on the active participation of various specialists in the area, encompasses an update on the diagnosis and treatment of insomnia in adults. To this end, it followed a structured methodology. Topics of interest related to diagnosis were written based on theoretical framework, evidence in the literature, and professional experience. As for the topics related to the treatment of insomnia, a series of questions were developed based on the PICO acronym (P - Patient, problem, or population; I - Intervention; C - Comparison, control, or comparator; O - Outcome). The work groups defined the eligible options within each of these parameters. Regarding pharmacological interventions, only the ones currently available in Brazil or possibly becoming available in the upcoming years were considered eligible. Systematic reviews were conducted to help prepare the texts and define the level of evidence for each intervention. The final result is an objective and practical document providing recommendations with the best scientific support available to professionals involved in the management of insomnia.