Adherence to wakefulness promoting medication in patients with narcolepsy

Pérez-Carbonell, Laura; Lyons, Elaine; Gnoni, Valentina; Higgins, Seán; Otaiku, Abidemi I.; Leschziner, Guy; Drakatos, Panagis; d’Ancona, G; Kent, Brian D.

doi:10.1016/j.sleep.2020.02.013

Cited by 11 publications

(7 citation statements)

References 18 publications

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“…A study of 116 people with narcolepsy found that while 55.2% of study participants took their medications at least 80% of the time, 12.9% took their medications only 50-80% of the time and 31.9% took their prescribed medications less than 50% of the time. 44 It is striking that until recently, only 5 medications had been indicated for the treatment of narcolepsy in the US, reflecting an ongoing need for increased treatment options to combat EDS and cataplexy in narcolepsy. Increased understanding of narcolepsy pathophysiology is enabling exploration of other candidate molecules and in 2019 two new compounds, pitolisant and solriamfetol, were approved in the US for treatment of excessive daytime sleepiness in narcolepsy.…”

Section: Treatment Landscape For Narcolepsymentioning

confidence: 99%

<p>Living with Narcolepsy: Current Management Strategies, Future Prospects, and Overlooked Real-Life Concerns</p>

Barker¹,

Flygare²,

Paruthi³

et al. 2020

NSS

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Narcolepsy is a neurological disorder of the sleep-wake cycle characterized by excessive daytime sleepiness (EDS), cataplexy, nighttime sleep disturbances, and REM-sleep-related phenomena (sleep paralysis, hallucinations) that intrude into wakefulness. Dysfunction of the hypocretin/orexin system has been implicated as the underlying cause of narcolepsy with cataplexy. In most people with narcolepsy, symptom onset occurs between the ages of 10 and 35 years, but because the disorder is underrecognized and testing is complex, delays in diagnosis and treatment are common. Narcolepsy is treated with a combination of lifestyle modifications and medications that promote wakefulness and suppress cataplexy. Treatments are often effective in improving daytime functioning for individuals with narcolepsy, but side effects and/or lack of efficacy can result in suboptimal management of symptoms and, in many cases, significant residual impairment. Additionally, the psychosocial ramifications of narcolepsy are often neglected. Recently two new pharmacologic treatment options, solriamfetol and pitolisant, have been approved for adults, and the indication for sodium oxybate in narcolepsy has been expanded to include children. In recent years, there has been an uptick in patient-centered research, and promising new diagnostic and therapeutic options are in development. This paper summarizes current and prospective pharmacological therapies for treating both EDS and cataplexy, discusses concerns specific to children and reproductive-age women with narcolepsy, and reviews the negative impact of health-related stigma and efforts to address narcolepsy stigma.

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Section: Treatment Landscape For Narcolepsymentioning

confidence: 99%

<p>Living with Narcolepsy: Current Management Strategies, Future Prospects, and Overlooked Real-Life Concerns</p>

Barker¹,

Flygare²,

Paruthi³

et al. 2020

NSS

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“…For patients with narcolepsy, overall medication adherence is suboptimal. One study reported that good adherence (≥80%) was observed for only 55.2% of patients, while 12.9% were intermediately adherent (51%–79%) and 31.9% were poorly adherent (≤50%) [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Once-nightly sodium oxybate (FT218) demonstrated improvement of symptoms in a phase 3 randomized clinical trial in patients with narcolepsy

Kushida

Shapiro

Roth

et al. 2021

Sleep

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Study Objectives To assess the efficacy and safety of FT218, a novel once-nightly formulation of sodium oxybate (ON-SXB), in patients with narcolepsy in the phase 3 REST-ON trial. Methods Narcolepsy patients aged ≥16 years were randomized 1:1 to uptitration of ON-SXB (4.5, 6, 7.5, and 9 g) or placebo. Three coprimary endpoints were change from baseline in mean sleep latency on the Maintenance of Wakefulness test, Clinical Global Impression-Improvement rating, and weekly cataplexy attacks at 9, 7.5, and 6 g. Secondary endpoints included change from baseline on the Epworth Sleepiness Scale. Safety included adverse drug reactions and clinical laboratory assessments. Results In total, 222 patients were randomized; 212 received ≥1 dose of ON-SXB (n=107) or placebo (n=105). For the 3 coprimary endpoints and Epworth Sleepiness Scale, all 3 doses of ON-SXB demonstrated clinically meaningful, statistically significant improvement vs placebo (all P<0.001). For ON-SXB 9 g vs placebo, increase in mean sleep latency was 10.8 vs 4.7 min (LSMD [95% CI], 6.13 [3.52–8.75]), 72.0% vs 31.6% were rated much/very much improved on Clinical Global Impression-Improvement (OR [95% CI], 5.56 [2.76–11.23]), change in mean weekly number of cataplexy attacks was –11.5 vs –4.9 (LSMD [95% CI], –6.65 [–9.32 to –3.98]), and change in Epworth Sleepiness Scale was –6.5 and –2.7 (LSMD [95% CI], –6.52 [–5.47 to –2.26]). Common adverse reactions included nausea, vomiting, headache, dizziness, and enuresis. Conclusions ON-SXB significantly improved narcolepsy symptoms; its safety profile was consistent with SXB. ON-SXB conferred efficacy with a clearly beneficial single nighttime dose.

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“…When immobilized or encouraged to sleep, narcoleptics can fall asleep very quickly. [18] Patients were instructed to attempt sleep every 2 hours on a multiple small sleep latency test (Multiple Sleep Latency Test). On average, narcoleptics fall asleep in less than 8 minutes out of 5 20-minute sleep opportunities, and they tend to take only 1 to 2 minutes, while people without narcoleptics usually take 10 to 20 minutes.…”

Section: Neurobiological Basis 121 the Function Of Or'exin Neuronsmentioning

confidence: 99%

TCM syndrome differentiation and treatment of narcolepsy based on neurobiological mechanism: A review

2022

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Narcolepsy is a relatively rare brain disorder caused by the selective loss of orexin neurons. Narcolepsy is divided into Narcolepsy Type 1 (NT1) and Narcolepsis Type 2 (NT2). The pathogenesis of NT1 has been well established due to the severe loss of orexin neurons, while NT2 is still poorly understood, and little is known about its underlying neurobiological mechanisms. human leukocyte antigen alleles have been found to strongly influence the development of narcolepsy, with more than 90% of NT1 patients carrying the human leukocyte antigen II allele DQB1*06:02. In addition to the genetic evidence for the DQBI*06:02 allele, some other evidence suggests that a T cell-mediated immune mechanism destroys the orexin neurons of NT1, with CD4 + T cells being key. For this disease, traditional Chinese medicine (TCM) therapy has its own characteristics and advantages, especially the combination of acupuncture and medicine in the treatment of this disease in TCM, which has made considerable and gratifying progress. The purpose of this review is to introduce the frontier progress of neurobiology of narcolepsy, and to explore the syndrome differentiation and treatment of narcolepsy with the combined use of TCM and Western medicine combined with TCM.

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Adherence to wakefulness promoting medication in patients with narcolepsy

Cited by 11 publications

References 18 publications

<p>Living with Narcolepsy: Current Management Strategies, Future Prospects, and Overlooked Real-Life Concerns</p>

<p>Living with Narcolepsy: Current Management Strategies, Future Prospects, and Overlooked Real-Life Concerns</p>

Once-nightly sodium oxybate (FT218) demonstrated improvement of symptoms in a phase 3 randomized clinical trial in patients with narcolepsy

TCM syndrome differentiation and treatment of narcolepsy based on neurobiological mechanism: A review

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