Suvorexant for insomnia: a systematic review of the efficacy and safety profile for this newly approved hypnotic – what is the number needed to treat, number needed to harm and likelihood to be helped or harmed?

@article{Citrome2014SuvorexantFI,
  title={Suvorexant for insomnia: a systematic review of the efficacy and safety profile for this newly approved hypnotic – what is the number needed to treat, number needed to harm and likelihood to be helped or harmed?},
  author={Leslie Citrome},
  journal={International Journal of Clinical Practice},
  year={2014},
  volume={68}
}
  • L. Citrome
  • Published 1 December 2014
  • Psychology
  • International Journal of Clinical Practice
To describe the efficacy and safety of suvorexant for the treatment of insomnia. 

Effectiveness of change from suvorexant to lemborexant drug in the treatment of sleep disorders

TLDR
Sleep disorders can be treated by alleviating difficulties in initiating sleep by changing from suvorexant to lemboreXant, and that the drug change caused no serious side effects and that it was highly safe and tolerated.

Suvorexant: a promising, novel treatment for insomnia

TLDR
More head-to-head studies comparing suvorexant to other sedative-hypnotic therapies are needed to further delineate which patients will benefit the most from this medication over others.

[Multimodality of clinical effects of orexin].

The article describes the main biological properties of orexin as a wakefulness hormone and its possible points of application in practical medicine. An example of a drug, which blocks orexin

Lemborexant for the Treatment of Insomnia: Direct and Indirect Comparisons With Other Hypnotics Using Number Needed to Treat, Number Needed to Harm, and Likelihood to Be Helped or Harmed.

TLDR
In Phase 3 trials, the benefit-risk ratio for lemborexant is favorable as measured by NNT, NNH, and LHH, suggesting that lemborxant has a clinically relevant magnitude of therapeutic effect.

Pharmacotherapy Treatment Options for Insomnia: A Primer for Clinicians

TLDR
The state of the art of pharmacotherapy with a reference to cognitive behavioral therapy for insomnia (CBT-I) as well is reviewed and a guide to all the Food and Drug Administration approved hypnotics including potential side effects is provided.

Relationship Between Constipation and Medication.

TLDR
The results of an analysis of the relationship between constipation and drugs are presented, which suggest that commonly prescribed drugs, such as hypnotics, are less well understood.

Suvorexant: a dual orexin receptor antagonist for the treatment of sleep onset and sleep maintenance insomnia.

TLDR
Clinical trials have shown suvorexant to be relatively safe and effective for the treatment of both sleep onset and sleep maintenance at doses of 20 mg or less, and it is the first dual orexin receptor antagonist approved for the Treatment of insomnia.

Suvorexant in insomnia: efficacy, safety and place in therapy

TLDR
Suvorexant is the first DORA to be approved and has demonstrated efficacy at decreasing both time to sleep onset and increasing total sleep time compared with placebo, and may represent an alternative for patients who cannot tolerate or do not receive benefit from traditional sleep agents.

Clinical pharmacology, efficacy, and safety of orexin receptor antagonists for the treatment of insomnia disorders

TLDR
ORAs have the potential to revolutionize the pharmacological treatment of insomnia because they not only improve sleep, but, in addition, appear to have no dependence – and tolerance-inducing effects, which makes them suitable for long-term-treatment.

Orexin receptor antagonists for the treatment of insomnia and potential treatment of other neuropsychiatric indications

TLDR
The role of orexin receptor antagonists in disorders of sleep/wake and other potential neuropsychiatric conditions, with a focus on suvorexant, which is currently the only approved agent in this class, is outlined.
...

References

SHOWING 1-10 OF 40 REFERENCES

Comparative efficacy of newer hypnotic drugs for the short‐term management of insomnia: a systematic review and meta‐analysis

TLDR
To compare the clinical effectiveness of zaleplon, zolpidem or zopiclone with either benzodiazepines licensed and approved for use in the UK for the short‐term management of insomnia or with each other, a comparison study is conducted.

First-in-class insomnia drug on the brink of approval nod

  • R. Osborne
  • Psychology
    Nature Reviews Drug Discovery
  • 2013
Merck's dual orexin receptor antagonist suvorexant is approaching the regulatory finish line, 15 years after orexins were discovered.

Suvorexant, a dual orexin receptor antagonist for the management of insomnia.

TLDR
Suvorexant, a dual orexin receptor antagonist for the management of insomnia and its application in clinical practice is described.

The Efficacy and Safety of Drug Treatments for Chronic Insomnia in Adults: A Meta-analysis of RCTs

TLDR
Benzodiazepines and non-benzodiazepine treatments for chronic insomnia are effective treatments in the management of chronic insomnia, although they pose a risk of harm.

Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits

TLDR
Improvements in sleep with sedative use are statistically significant, but the magnitude of effect is small, and the increased risk of adverse events is statistically significant and potentially clinically relevant in older people at risk of falls and cognitive impairment.

Benzodiazepines and zolpidem for chronic insomnia: a meta-analysis of treatment efficacy.

TLDR
Benzodiazepines and zolpidem produced reliable improvements in commonly measured parameters of sleep in patients with chronic insomnia, and presented challenges for developing evidence-based guidelines for the use of hypnotics in the management of chronic insomnia.

Meta-analysis of benzodiazepine use in the treatment of insomnia.

TLDR
The use of benzodiazepines in the treatment of insomnia is associated with an increase in sleep duration, but this is countered by a number of adverse effects and additional studies evaluating the efficacy of nonpharmacological interventions would be valuable.

Compelling or irrelevant? Using number needed to treat can help decide

  • L. Citrome
  • Medicine, Political Science
    Acta psychiatrica Scandinavica
  • 2008
Objective:  The metric of number needed to treat (NNT), defined as the number of patients who need to be treated to achieve one additional favorable outcome, can help clinicians appraise claims that

Orexin receptor antagonism for treatment of insomnia

TLDR
The data suggest that orexin receptor antagonism offers a novel approach to treating insomnia, and Class I evidence that suvorexant improves sleep efficiency over 4 weeks in nonelderly adult patients with primary insomnia.