Assessment of Switching to Suvorexant versus the Use of Add-on Suvorexant in Combination with Benzodiazepine Receptor Agonists in Insomnia Patients: A Retrospective Study
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Objective: Suvorexant is a novel hypnotic drug that does not interact with the conventional γ-aminobutyric acid (GABA)-A receptor. We investigated the method by which suvorexant was introduced in insomnia patients who were taking benzodiazepine receptor agonists (BzRA). Methods: This was a retrospective study. We extracted clinical data for patients who were prescribed suvorexant and were already using BzRA. The patients were assigned to two groups, the switching and add-on groups. We assessed the suvorexant discontinuation rate at one month after the prescription of the drug. Results: One hundred and nineteen patients were assigned to the switching group, and 109 were assigned to the add-on group. The add-on group exhibited a significantly higher all-cause discontinuation rate than the switching group (odds ratio, 2.7; 95% confidence interval, 1.5 to 5.0; adjusted p＜0.001). Intolerability was a significantly stronger risk factor for suvorexant discontinuation in the add-on group (22.0% vs. 7.6%, p＜0.002), and the most common adverse effect was oversedation. Conclusion: Our results show that the add-on of suvorexant increases the frequency of oversedation compared with switching in insomnia patients that are taking BzRA. However, this was only a preliminary retrospective study, and further studies will be required to confirm our findings.
Abstract
Objective: Suvorexant is a novel hypnotic drug that does not interact with the conventional γ-aminobutyric acid (GABA)-A receptor. We investigated the method by which suvorexant was introduced in insomnia patients who were taking benzodiazepine receptor agonists (BzRA). Methods: This was a retrospective study. We extracted clinical data for patients who were prescribed suvorexant and were already using BzRA. The patients were assigned to two groups, the switching and add-on groups. We assessed the suvorexant discontinuation rate at one month after the prescription of the drug. Results: One hundred and nineteen patients were assigned to the switching group, and 109 were assigned to the add-on group. The add-on group exhibited a significantly higher all-cause discontinuation rate than the switching group (odds ratio, 2.7; 95% confidence interval, 1.5 to 5.0; adjusted p＜0.001). Intolerability was a significantly stronger risk factor for suvorexant discontinuation in the add-on group (22.0% vs. 7.6%, p＜0.002), and the most common adverse effect was oversedation. Conclusion: Our results show that the add-on of suvorexant increases the frequency of oversedation compared with switching in insomnia patients that are taking BzRA. However, this was only a preliminary retrospective study, and further studies will be required to confirm our findings.
참고문헌 (24)
- Liu X, "Sleep loss and daytime sleepiness in the general adult population of Japan", Psychiatry Res, 93, pp.1~11 (2000)[DOI]
- Morin CM, "The natural history of insomnia: a population-based 3-year longitudinal study", Arch Intern Med, 169, pp.447~453 (2009)[DOI]
- Smith E, "Pharmacotherapy for insomnia in primary care", Prim Care Companion CNS Disord, 18, pp.10~ (2016)
- Wilt TJ, "Pharmacologic treatment of insomnia disorder: An evidence report for a clinical practice guideline by the American College of Physicians", Ann Intern Med, 165, pp.103~112 (2016)[DOI]
- Siriwardena AN, "GPs' attitudes to benzodiazepine and 'Z-drug' prescribing: a barrier to implementation of evidence and guidance on hypnotics", Br J Gen Pract, 56, pp.964~967 (2006)
- 김희윤, "Prescription Patterns for Patients with Schizophrenia in Korea: A Focus on Antipsychotic Polypharmacy", Clinical Psychopharmacology and Neuroscience, 12(2), pp.128~136 (2014), 대한정신약물학회
- Wick JY, "The history of benzodiazepines", Consult Pharm, 28, pp.538~548 (2013)[DOI]
- Petursson H, "The benzodiazepine withdrawal syndrome", Addiction, 89, pp.1455~1459 (1994)[DOI]
- Sorock GS, "Benzodiazepine sedatives and the risk of falling in a community-dwelling elderly cohort", Arch Intern Med, 148, pp.2441~2444 (1988)[DOI]
- Tiihonen J, "Polypharmacy with antipsychotics, antidepressants, or benzodiazepines and mortality in schizophrenia", Arch Gen Psychiatry, 69, pp.476~483 (2012)[DOI]
- Bertisch SM, "National use of prescription medications for insomnia: NHANES 1999-2010", Sleep, 37, pp.343~349 (2014)[DOI]
- Sakurai T, "The neural circuit of orexin (hypocretin): maintaining sleep and wakefulness", Nat Rev Neurosci, 8, pp.171~181 (2007)
- Norman JL, "Novel class of medications, orexin receptor antagonists, in the treatment of insomnia - critical appraisal of suvorexant", Nat Sci Sleep, 8, pp.239~247 (2016)[DOI]
- Stahl SM, "Mechanism of action of suvorexant", CNS Spectr, 21, pp.215~218 (2016)[DOI]
- Michelson D, "Safety and efficacy of suvorexant during 1-year treatment of insomnia with subsequent abrupt treatment discontinuation: a phase 3 randomised, double-blind, placebo-controlled trial", Lancet Neurol, 13, pp.461~471 (2014)[DOI]
- Inada T, "Psychotropic dose equivalence in Japan", Psychiatry Clin Neurosci, 69, pp.440~447 (2015)[DOI]
- Kanda Y, "Investigation of the freely available easy-to-use software 'EZR' for medical statistics", Bone Marrow Transplant, 48, pp.452~458 (2013)[DOI]
- Kishi T, "Suvorexant for primary insomnia: a systematic review and meta-analysis of randomized placebo-controlled trials", PLoS One, 10, pp.e0136910~ (2015)[DOI]
- Tyrer P, "Risks of dependence on benzodiazepine drugs: the importance of patient selection", BMJ, 298, pp.102~ (1989)
- Herring WJ, "Suvorexant in patients with insomnia: Results from two 3-month randomized controlled clinical trials", Biol Psychiatry, 79, pp.136~148 (2016)[DOI]
- Ashton H, "The treatment of benzodiazepine dependence", Addiction, 89, pp.1535~1541 (1994)[DOI]
- Voshaar RC, "Strategies for discontinuing long-term benzodiazepine use: meta-analysis", Br J Psychiatry, 189, pp.213~220 (2006)[DOI]
- Rickels K, "Trazodone and valproate in patients discontinuing long-term benzodiazepine therapy: effects on withdrawal symptoms and taper outcome", Psychopharmacology (Berl), 141, pp.1~5 (1999)[DOI]
- Baandrup L, "Prolonged-release melatonin versus placebo for benzodiazepine discontinuation in patients with schizophrenia or bipolar disorder: A randomised, placebo-controlled, blinded trial", World J Biol Psychiatry, 17, pp.514~524 (2016)