Ufer M, Kelsh D, Schoedel KA, Dingemanse J. Abuse potential assessment of the new dual orexin receptor antagonist daridorexant in recreational sedative drug users as compared to suvorexant and zolpidem.
Sleep 2021;
45:6364001. [PMID:
34480579 DOI:
10.1093/sleep/zsab224]
[Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 07/30/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES
Abuse potential properties have been reported for the dual orexin receptor antagonists (DORAs) suvorexant and lemborexant. Daridorexant is a new DORA currently in late-stage clinical development. This randomized, double-blind, double-dummy, placebo- and active-controlled 6-period crossover study assessed its abuse potential in healthy recreational sedative drug users (n=63).
METHODS
In each study period, a single, oral, morning dose of either daridorexant (50, 100, 150 mg), placebo, or active control, i.e., suvorexant (150 mg) or zolpidem (30 mg), was administered. Primary pharmacodynamic endpoint was the Emax of the Drug-liking visual analog scale (VAS) assessed over 24 h. Several secondary subjective and objective pharmacodynamic endpoints were also assessed.
RESULTS
Study validity was confirmed based on drug-liking of suvorexant and zolpidem greater than placebo applying a pre-defined 15-point validity margin (p<0.0001). Drug-liking VAS Emax (mean; 95% CI) of daridorexant at 50 mg (73.2; 69.0-77.5) was significantly lower compared to suvorexant (80.7; 77.0-84.5) and zolpidem (79.9; 76.2-83.5) (p<0.001), but similar at 100 mg (79.1; 75.0-83.3) and 150 mg (81.3; 77.7, 84.8). Such dose-related patterns were also observed for most secondary endpoints. At each daridorexant dose, Drug-liking VAS scores were greater than placebo. Both control drugs and daridorexant were safe and the pharmacokinetics of daridorexant was consistent with earlier trials indicating quick absorption and elimination.
CONCLUSIONS
In this large, valid human abuse potential study, daridorexant showed dose-related drug-liking among recreational sedative drug users with lower effects at the highest phase-3 dose, and similar effects at higher doses compared to supratherapeutic doses of suvorexant and zolpidem.
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