Ability of suvorexant to prevent delirium in patients in the intensive care unit: a randomized controlled trial

Azuma, Kazunari; Takaesu, Yoshikazu; Soeda, Hiroshi; Iguchi, Aki; Uchida, Kôtarô; Ohta, Shöichi; Mishima, Shiro; Inoue, Takeshi; Inoue, Yuichi; Oda, Jun

doi:10.1002/ams2.368

Cited by 22 publications

(27 citation statements)

References 31 publications

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“…Remarkably, patients taking ramelteon and/or suvorexant developed delirium less frequently than those who were not. This finding from large-scale real-world practice is consistent with our previous RCTs involving ramelteon and suvorexant, [25][26][27][28] which strengthens the evidence of the effects of ramelteon and/or suvorexant on delirium prevention.…”

Section: Effects Of Ramelteon And/or Suvorexant On Delirium Preventiosupporting

confidence: 91%

Real-World Effectiveness of Ramelteon and Suvorexant for Delirium Prevention in 948 Patients With Delirium Risk Factors

Hatta¹,

Kishi²,

Wada³

et al. 2019

J. Clin. Psychiatry

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Objective:The aim of this study was to examine the effectiveness of ramelteon and suvorexant for delirium prevention in real-world practice. It explored whether ramelteon and/or suvorexant would affect delirium prevention among both patients at risk for but without delirium (patients at risk) and those with delirium the night before a consultation. Methods: This multicenter, prospective, observational study was conducted by trained psychiatrists at consultation-liaison psychiatric services from October 1, 2017, to October 7, 2018. Patients who were aged 65 years or older and hospitalized because of acute diseases or elective surgery, had risk factors for delirium, and had insomnia or delirium on the night before the consultation were prescribed ramelteon and/or suvorexant. The decision to take medication was left to the discretion of each patient. The primary outcome was incidence of delirium based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, during the first 7 days. Results:Among 526 patients at risk, those taking ramelteon and/or suvorexant developed delirium significantly less frequently than those who did not, after control for the effects of risk factors on the estimate of an independent association between the effects of ramelteon and/or suvorexant and the outcome of developing delirium (15.7% vs 24.0%; odds ratio [OR] = 0.48;, 95% CI, 0.29-0.80; P = .005). Similar results were found among 422 patients with delirium (39.9% vs 66.3%; OR = 0.36; 95% CI, 0.22-0.59; P < .0001). Conclusions: Ramelteon and suvorexant appear to be effective for delirium prevention in real-world practice. J Clin Psychiatry 2020;81 (1):19m12865 To cite: Hatta K, Kishi Y, Wada K, et al. Real-world effectiveness of ramelteon and suvorexant for delirium prevention in 948 patients with delirium risk factors.

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Section: Effects Of Ramelteon And/or Suvorexant On Delirium Preventiosupporting

confidence: 91%

Real-World Effectiveness of Ramelteon and Suvorexant for Delirium Prevention in 948 Patients With Delirium Risk Factors

Hatta¹,

Kishi²,

Wada³

et al. 2019

J. Clin. Psychiatry

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“…Three studies were designed as prospective RCTs, [ 17 , 20 , 24 ] while the other 4 were retrospective case-control studies. [ 16 , 18 , 19 , 21 ] Two trials were performed for patients in ICU, [ 19 , 20 ] 4 for non-ICU population [ 16 , 18 , 21 , 24 ] and 1 included both of the ICU and non-ICU patients. [ 17 ] The average daily dose was 15 or 20 mg.…”

Section: Resultsmentioning

confidence: 99%

“…[ 17 ] Kawada et al demonstrated the addition of suvorexant to ramelteon reduced the delirium risk in acute stroke patients (7.0% vs 31%, P < .001). [ 18 ] However, some studies supported the negative effects of suvorexant on delirium prevention (Masuyama et al: 43.8% vs 58.8%; P = .149 [ 19 ] ; Azuma et al: 14.7% vs 33.9%; P = .069 [ 20 ] ; Booka et al: 0% vs 11.1%; P = .418 [ 21 ] ) compared with the non-suvorexant group. Hereby, it is necessary to comprehensively evaluate the efficacy of suvorexant for delirium prevention by integrating all relevant evidence.…”

Section: Introductionmentioning

confidence: 99%

Suvorexant for the prevention of delirium

Xu¹,

Cui²,

Shen

et al. 2020

Medicine

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Background: Delirium is a frequently encountered complication, which is associated with increased mortality. Suvorexant, an approved agent for the treatment of insomnia, is recently suggested to be also effective for prevention of delirium by some authors. However, a consensus has yet to be reached. The goal of this study was to perform a meta-analysis to overall estimate the effectiveness of suvorexant in preventing delirium and its related consequences. Methods: Eligible studies were identified by searching online databases of PubMed, EMBASE, and Cochrane Library. The pooled OR was calculated for binary outcomes (e.g., the incidence of delirium, mortality, or adverse events), while standardized mean difference (SMD) were expressed for continuous outcomes (e.g., time to delirium onset, length of stay in hospital and ICU, time on ventilation). Results: Seven studies which comprised 402 suvorexant treatment patients and 487 patients with control treatment were included in this meta-analysis. Overall, pooled analysis indicated the incidence of delirium could be significantly reduced (OR, 0.30; P < .001) and time to delirium onset was significantly lengthened (SMD, 0.44; P = .006) in patients undergoing suvorexant treatment compared with controls. Suvorexant had no beneficial effects on the secondary outcomes [length of stay in hospital (SMD, −0.65; P = .161) and ICU (SMD, 0.34; P = .297), time on ventilation (SMD, 1.09; P = .318), drug-related adverse events (OR, drug-related adverse events (OR, 1.66; P = .319) and mortality (OR, 2.21; P = .261)]. Subgroup analysis also confirmed the benefit of suvorexant on the development of delirium, which was significant in any subgroup. Conclusion: Suvorexant should be recommended for the prevention of delirium in clinic.

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“…20,28,34 In adults, new agents, such as suvorexant (randomized, controlled study), would have a beneficial effect on the prevention of delirium. 35 L a s t l y , m e l a t o n i n l e v e l s a r e r e d u c e d in critically-ill patients, which opens up the expectations for its use, and it may prevent the evolutionary course toward delirium. Some studies have reported adequate results with melatonin or agonists.…”

Section: The Hospital Settingmentioning

confidence: 99%

Causes and effects of lack of sleep in hospitalized children

Vecchi

2020

Arch Argent Pediat

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Sleep is a key function that takes up one third of our lives. Sleep deprivation may lead to physical and psychological disorders in the short and long term. Hospitalization, regardless of its cause, does not favor good enough and restorative sleep. It is affected by both external (light, noise) and internal (procedures, drugs, care) factors. The intensive care unit is the place where falling asleep and maintaining sleep is more difficult. This is in addition to disease severity and the characteristics of its structure and functioning. A poor sleep quantity or quality may trigger an acute confusional state, which often affects hospitalized children, known as delirium. Promoting a joint effort among all sectors of the hospital setting targeted at protecting sleep as much as possible is the required task.

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Ability of suvorexant to prevent delirium in patients in the intensive care unit: a randomized controlled trial

Cited by 22 publications

References 31 publications

Real-World Effectiveness of Ramelteon and Suvorexant for Delirium Prevention in 948 Patients With Delirium Risk Factors

Real-World Effectiveness of Ramelteon and Suvorexant for Delirium Prevention in 948 Patients With Delirium Risk Factors

Suvorexant for the prevention of delirium

Causes and effects of lack of sleep in hospitalized children

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