PMID- 34121443
OWN - NLM
STAT- MEDLINE
DCOM- 20211122
LR  - 20230804
IS  - 2376-1032 (Electronic)
IS  - 2376-0540 (Print)
IS  - 2376-0540 (Linking)
VI  - 27
IP  - 9
DP  - 2021 Sep
TI  - Comparative efficacy of lemborexant and other insomnia treatments: a network 
      meta-analysis.
PG  - 1296-1308
LID - 10.18553/jmcp.2021.21011 [doi]
AB  - BACKGROUND: Insomnia is a common disorder associated with a substantial burden of 
      illness, particularly in older adults. OBJECTIVE: To compare the efficacy and 
      safety of lemborexant with specified other insomnia treatments through a 
      systematic literature review and network meta-analysis (NMA). METHODS: Medline 
      and Embase were systematically searched from inception to February 2019 and 
      updated with a targeted search of PubMed for pivotal trials in March 2021. 
      Randomized controlled trials in adults with primary insomnia were included if 
      they reported results following at least 1 week of treatment. Interventions of 
      interest were specified as lemborexant, suvorexant, benzodiazepines, 
      benzodiazepine receptor agonists (also called Z-drugs [zolpidem, eszopiclone, 
      zaleplon, zopiclone]), trazodone, and ramelteon. Efficacy outcomes included wake 
      after sleep onset (WASO), sleep efficiency (SE), latency to persistent sleep 
      (LPS)/sleep onset latency (SOL), total sleep time (TST) and Insomnia Severity 
      Index (ISI). Bayesian NMA were performed at predetermined time intervals 
      approximating 4 weeks, 3 months, and 6 months. Safety outcomes included serious 
      adverse events (SAEs), withdrawals due to adverse events (AEs), and specified AEs 
      (dizziness, somnolence, and falls). Subgroup analysis was conducted in the older 
      population. RESULTS: 45 studies were included in the NMA. At 4 weeks, lemborexant 
      had the highest probability of being the best treatment for 3 of the 4 outcomes 
      measured objectively by polysomnography-TST, LPS, and SE-and was ranked second to 
      suvorexant on WASO. Eszopiclone was highly ranked for subjectively measured SOL 
      and ISI at 4 weeks, 3 months, and 6 months. Lemborexant was rated more highly 
      than suvorexant in subjective measures of WASO, TST, and SOL at 4 weeks (the 
      differences were not statistically significant). No statistically significant 
      interactions between treatment effect and older subpopulations were found, 
      indicating that the treatment effect was similar in older and adult populations. 
      The safety profile of lemborexant was broadly similar to the other treatments for 
      SAEs and withdrawals due to AEs. A limitation is the age of some of the included 
      studies (3 were published in 1990 or earlier). A further limitation is the lack 
      of stratification of recommended doses. If the doses used in the study 
      publications do not reflect doses used in clinical practice, this could 
      potentially bias the results. CONCLUSIONS: Lemborexant was ranked highest of the 
      treatments studied on 3 out of the 4 objectively measured insomnia efficacy 
      outcomes, with a safety profile broadly similar to other insomnia treatments. 
      DISCLOSURES: This work was funded by Eisai Inc., which was involved with all 
      stages of the study and analysis. McElroy, O'Leary, and Adena are consultants 
      with Datalytics Pty Ltd., which was paid by Eisai Inc. for conducting the 
      literature review and analysis. They were not financially compensated for 
      collaborative efforts on publication-related activities. Campbell, Tahami 
      Monfared, and Meier are employed by Eisai Inc. This study was presented as a 
      poster at AMCP Nexus Virtual, October 20-23, 2020 and at the AGS Virtual Annual 
      Scientific Meeting 2021, May 13-15, 2021.
FAU - McElroy, Heather
AU  - McElroy H
AD  - Datalytics, Kingston ACT, Australia.
FAU - O'Leary, Beth
AU  - O'Leary B
AD  - Datalytics, Kingston ACT, Australia.
FAU - Adena, Michael
AU  - Adena M
AD  - Datalytics, Kingston ACT, Australia.
FAU - Campbell, Renee
AU  - Campbell R
AD  - Eisai Inc., Woodcliff Lake, NJ.
FAU - Monfared, Amir Abbas Tahami
AU  - Monfared AAT
AD  - Eisai Inc., Woodcliff Lake, NJ.
FAU - Meier, Genevieve
AU  - Meier G
AD  - Eisai Inc., Woodcliff Lake, NJ.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20210612
PL  - United States
TA  - J Manag Care Spec Pharm
JT  - Journal of managed care & specialty pharmacy
JID - 101644425
RN  - 0 (Orexin Receptor Antagonists)
RN  - 0 (Pyridines)
RN  - 0 (Pyrimidines)
RN  - 0K5743G68X (lemborexant)
SB  - IM
MH  - Humans
MH  - Orexin Receptor Antagonists/*therapeutic use
MH  - Pyridines/*therapeutic use
MH  - Pyrimidines/*therapeutic use
MH  - Sleep Initiation and Maintenance Disorders/*drug therapy
MH  - Treatment Outcome
PMC - PMC10394202
COIS- This work was funded by Eisai Inc., which was involved with all stages of the 
      study and analysis. McElroy, O'Leary, and Adena are consultants with Datalytics 
      Pty Ltd., which was paid by Eisai Inc. for conducting the literature review and 
      analysis. They were not financially compensated for collaborative efforts on 
      publication-related activities. Campbell, Tahami Monfared, and Meier are employed 
      by Eisai Inc. This study was presented as a poster at AMCP Nexus Virtual, October 
      20-23, 2020 and at the AGS Virtual Annual Scientific Meeting 2021, May 13-15, 
      2021.
EDAT- 2021/06/15 06:00
MHDA- 2021/11/23 06:00
PMCR- 2021/09/01
CRDT- 2021/06/14 08:54
PHST- 2021/06/15 06:00 [pubmed]
PHST- 2021/11/23 06:00 [medline]
PHST- 2021/06/14 08:54 [entrez]
PHST- 2021/09/01 00:00 [pmc-release]
AID - 10.18553/jmcp.2021.21011 [doi]
PST - ppublish
SO  - J Manag Care Spec Pharm. 2021 Sep;27(9):1296-1308. doi: 10.18553/jmcp.2021.21011. 
      Epub 2021 Jun 12.