Hypnotic prescription trends and patterns for the treatment of insomnia in Japan: analysis of a nationwide Japanese claims database

Abstract

Background There is limited consensus regarding the optimal treatment of insomnia. The recent introduction of orexin receptor antagonists (ORA) has increased the available treatment options. However, the prescribing patterns of hypnotics in Japan have not been comprehensively assessed. We performed analyses of a claims database to investigate the real-world use of hypnotics for treating insomnia in Japan. Methods Data were retrieved for outpatients (aged ≥ 20 to < 75 years old) prescribed ≥ 1 hypnotic for a diagnosis of insomnia between April 1st, 2009 and March 31st, 2020, with ≥ 12 months of continuous enrolment in the JMDC Claims Database. Patients were classified as new or long-term users of hypnotics. Long-term use was defined as prescription of the same mechanism of action (MOA) for ≥ 180 days. We analyzed the trends (2010–2019) and patterns (2018–2019) in hypnotics prescriptions. Results We analyzed data for 130,177 new and 91,215 long-term users (2010–2019). Most new users were prescribed one MOA per year (97.1%–97.9%). In 2010, GABAA-receptor agonists (benzodiazepines [BZD] or z-drugs) were prescribed to 94.0% of new users. Prescriptions for BZD declined from 54.8% of patients in 2010 to 30.5% in 2019, whereas z-drug prescriptions remained stable (~ 40%). Prescriptions for melatonin receptor agonist increased slightly (3.2% to 6.3%). Prescriptions for ORA increased over this time from 0% to 20.2%. Prescriptions for BZD alone among long-term users decreased steadily from 68.3% in 2010 to 49.7% in 2019. Prescriptions for ORA were lower among long-term users (0% in 2010, 4.3% in 2019) relative to new users. Using data from 2018–2019, multiple (≥ 2) MOAs were prescribed to a higher proportion of long-term (18.2%) than new (2.8%) users. The distribution of MOAs according to psychiatric comorbidities, segmented by age or sex, revealed higher proportions of BZD prescriptions in elderly (new and long-term users) and male (new users) patients in all comorbidity segments. Conclusion Prescriptions for hypnotics among new and long-term users in Japan showed distinct patterns and trends. Further understanding of the treatment options for insomnia with accumulating evidence for the risk–benefit balance might be beneficial for physicians prescribing hypnotics in real-world settings.

Lemborexant‐induced interstitial lung disease: A case report

“…Additionally, network meta‐analysis revealed that lemborexant was the best profile from the aspects of efficacy, acceptability, tolerability, and safety 2 . Therefore, the proportions of patients with insomnia receiving ORA has been increasing from 0% in 2013 to 20% in 2019 3 …”

The effect of education regarding treatment guidelines for schizophrenia and major depressive disorders on psychiatrists' hypnotic medication prescribing behavior: a multicenter study

“…Second, it may reflect changes in the prescription of hypnotic medications over time. A study using the Japanese clime database reported a significant decrease in BZA and an increase in ORA from 2010 to 2019 [ 17 ]. However, this study took this into account and adjusted for the year in which the data were obtained as a covariate.…”

“…First, the types of hypnotic medications used in clinical practice have changed over time. Recently, orexin receptor antagonists (ORA), which are novel hypnotic medications with novel mechanisms of action, have been developed, and studies using large Japanese databases have shown that the types of hypnotic medications used have changed significantly [ 17 , 18 ]. The second is the recent reform of the reimbursement system for prescribing hypnotic medications.…”

Treatment strategies for insomnia in Japanese primary care physicians’ practice: A Web-based questionnaire survey

“…Whether the participants’ prescribing trends reflect the broader medical situation remains unclear, as there are no studies on the actual prescribing of sleep medications in Japan for 2022, when this survey was conducted. A pharmacoepidemiologic study using a nationwide Japanese claims database reported that between 2010 and 2019, benzodiazepine prescriptions decreased from 54.8% to 30.5%, MRAs increased slightly from 3.2% to 6.3%, ORAs increased significantly from 0% to 20.2%, and Z-drugs remained stable at approximately 40% [ 32 ]. Considering prescribing trends in the previous study [ 32 ], Japanese primary care physicians seem to prefer novel sleep medications.…”

“…A pharmacoepidemiologic study using a nationwide Japanese claims database reported that between 2010 and 2019, benzodiazepine prescriptions decreased from 54.8% to 30.5%, MRAs increased slightly from 3.2% to 6.3%, ORAs increased significantly from 0% to 20.2%, and Z-drugs remained stable at approximately 40% [ 32 ]. Considering prescribing trends in the previous study [ 32 ], Japanese primary care physicians seem to prefer novel sleep medications. The results of this study on ORAs align with those of a systematic review and network meta-analysis (NMA) published in 2023 by Yue et al [ 31 ].…”