Dual Orexin Receptor Antagonist, Almorexant, in Elderly Patients With Primary Insomnia: A Randomized, Controlled Study

Abstract

Two-night oral administration of almorexant was effective and well tolerated in treating primary insomnia in elderly patients.

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

“…The initial proof‐of‐concept that ORAs might be effective treatments for insomnia was established with the DORA almorexant/ACT‐078573 (Brisbare‐Roch et al., ; Hoever et al., ). Published results show generally similar findings to those described above for suvorexant (Black et al., ; Hoever et al., ; Roth et al., ). Development of almorexant was discontinued due to infrequent transient increases in liver enzymes unrelated to the orexin mechanism (Hoch, Van Gorsel, Van Gerven, & Dingemanse, ).…”

Optical probing of orexin/hypocretin receptor antagonists

“…Importantly, these findings have strong implications for various sleep-related conditions such as insomnia characterized by bouts of wakefulness after sleep onset (WASO) [47]. Indeed, Suvorexant and Almorexant are effective to decrease bouts of wakefulness in patients with insomnia characterized by WASO [30,43] and the data presented here suggest that this may be a result of its effects on specific sleep features such as increasing NREM sleep and the intrusion of NREM sleep into wakefulness.…”

“…Multiple lines of study have examined the effect of selective or dual OX1R and OX2R antagonism on sleep modulation [19][20][21][22][23][24][25][26][27][28][29]. ACT-078573 (Almorexant), a dual OX1/2R antagonist, has been shown to be effective in treatment of primary insomnia in humans [30], and has been shown to increase both non-rapid eye movement (NREM) and rapid eye movement (REM) sleep as measured by electroencephalogram (EEG) and electromyography (EMG) or behavioral changes, in rats, canines, and humans [19]. Suvorexant, a dual OX1/2R antagonist is effective in decreasing sleep latency, and has comparable EEG spectral profiles to normal sleep [20,26,27].…”

The Impact of Electronic Reading Devices on Reading Speed and Comfort in Patients with Decreased Vision

“…In one example, Falkenstein et al [7] demonstrated that patients achieved better VA when using the Early Treatment Diabetic Retinopathy Study (ETDRS) chart, which has a background luminance of 121.0 cd/m 2 , than when using the standard Snellen chart, which has a background luminance of 65.0 cd/m 2 . Similarly, our prior study found that near VA was approximately 1 line better when measured on a back-illuminated electronic device than when measured on an equivalent Rosenbaum near vision card [8]. As a result, back-illumination may be one strategy for improving VA and reading performance.…”

“…The advantage of back-illumination was even more pronounced in participants with lower VA (Table 2, Figure 1). Given that reading performance has been shown to be a function of multiple visual parameters such as VA, contrast sensitivity, and fixation stability, this improvement in reading speed may, in part, be due to the ability of back-illuminated devices to enhance text contrast and VA, especially in those with impaired visual function [3–5, 8]. …”