Real-World Preventive Effects of Suvorexant in Intensive Care Delirium

Izuhara, Muneto; Izuhara, Hisae Kihara; Tsuchie, Keiko; Araki, Toshimitsu; Ito, Tsukasa; Sato, Kouhei; Miura, Shingo; Otsuki, Koji; Nagahama, Michiharu; Hayashida, Maiko; Hashioka, Sadayuki; Wake, Rei; Kimura, Tomohiro; Tsumoto, Shusaku; Saito, Yoji; Inagaki, Masumi

doi:10.4088/jcp.20m13362

Cited by 15 publications

(19 citation statements)

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“…There were a few patients taking other psychotropic drugs (tricyclic antidepressants ( n = 1), antipsychotics ( n = 1) and suvorexant ( n = 4)) which might affect the onset of delirium, and these factors were not included in the analysis because of their small numbers. However, as these might affect the onset of delirium, especially suvorexant, which has been reported to prevent delirium, 22 they might also be related to the relative low incidence of postoperative delirium in this study.…”

Section: Discussionmentioning

confidence: 72%

Relationship between preoperative anxiety and onset of delirium after cardiovascular surgery in elderly patients: focus on personality and coping process

et al. 2022

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Background Postoperative delirium is associated with increased mortality. Therefore, it is important to manage delirium during the entire perioperative period. Preoperative anxiety is associated with poor prognosis in postoperative patients who have undergone cardiovascular surgery. This study aims to investigate the relationship between preoperative anxiety and onset of delirium after cardiovascular surgery in elderly patients (aged 65 years or older), considering the individual psychological characteristics, such as personality and stress coping skills in response to anxiety, as confounding factors. Methods This prospective study included patients aged >65 years in a preoperative state before undergoing cardiovascular surgery. Subjects were divided into two groups based on whether they experienced postoperative delirium, or not. We compared clinical and demographic factors, preoperative psychiatric and psychological factors, and intraoperative and perioperative physical factors between the control and delirium groups. Multiple imputations were used to account for missing data. Results Out of 168 subjects enrolled in this study, 26 (15.5%) developed postoperative delirium. Univariate analysis showed significant differences in age (P = 0.027), cognitive function (P = 0.007), agreeableness (P = 0.029), and the Acute Physiology and Chronic Health Evaluation‐II (APACHE‐II) score (P = 0.023) between the delirium and control groups. Multiple logistic regression analysis did not identify a significant association between preoperative anxiety and the onset of postoperative delirium. However, age (odds ratio (OR) = 1.114, P = 0.018), agreeableness (OR = 0.555, P = 0.008), and the APACHE‐II score (OR = 1.227, P = 0.008) were identified as risk factors for postoperative delirium. Conclusion Agreeableness, one of the personality traits associated with preoperative anxiety, appears to be involved in the development of postoperative delirium as an independent psychological factor, regardless of age or physical factors.

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Section: Discussionmentioning

confidence: 72%

Relationship between preoperative anxiety and onset of delirium after cardiovascular surgery in elderly patients: focus on personality and coping process

et al. 2022

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“…Hand searching of citations and meeting abstracts yielded one further article 24 that met our inclusion criteria. Finally, two randomized controlled trials, 25,26 seven cohort studies 15,16,24,[27][28][29][30] and two case-control studies 31,32 were included in the meta-analysis. The study flow diagram including reasons for exclusion is presented according to PRISMA guidelines as Figure 1.…”

Section: Study Selectionmentioning

confidence: 99%

“…The subjects were mainly elderly inpatients. Six studies [24][25][26]29,30,32 explored the effect of suvorexant without ramelteon on the incidence of delirium, and five studies 15,16,27,28,31 compared the effect of suvorexant with ramelteon on delirium prevention. Five studies 15,24,29,31,32 involved patients undergoing surgery.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Five studies 15,24,29,31,32 involved patients undergoing surgery. The suvorexant dose was 15 mg or 20 mg, and the ramelteon dose was 8 mg. Six studies 15,24,27,28,30,32 involved the use of benzodiazepine. The diagnostic tools for delirium were different among these studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The diagnostic tools for delirium were different among these studies. The Intensive Care Delirium Screening Checklist (ICDSC), 24,29 the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 32 the fifth edition of DSM (DSM-V), 15,16,25,26,31 and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) 16,27,28 were used as diagnostic tools for delirium.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Suvorexant with or without ramelteon to prevent delirium: a systematic review and meta‐analysis

2021

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Delirium is a common and serious neurobehavioral syndrome, associated with prolonged hospital stays, and increased morbidity and mortality. As it remains unclear whether suvorexant with or without ramelteon prevents delirium in elderly hospitalized patients, we conducted a systematic review and meta‐analysis to evaluate, searching the PubMed, Cochrane Library, Web of Science, EMBASE, and EBSCOhost databases for all randomized controlled trials (RCTs), case–control studies, and cohort studies that investigated the effects of suvorexant with or without ramelteon on delirium in adult hospitalized patients. The primary outcome was the incidence of delirium. Two randomized controlled trials, 7 cohort studies and 2 case–control studies involving 2594 patients were included in this meta‐analysis. The results showed that both suvorexant alone (odds ratio (OR) = 0.30, 95% confidence interval (CI): 0.14–0.65, P = 0.002) and suvorexant with ramelteon (OR = 0.39, 95% CI 0.23–0.65, P = 0.0003) reduced the incidence of delirium in adult hospitalized patients. Six studies involved the use of benzodiazepines; subgroup analysis performed separately in the suvorexant alone and suvorexant with ramelteon groups indicated that when benzodiazepine was administered, suvorexant with ramelteon was effective at reducing the incidence of delirium (OR = 0.53, 95% CI 0.37–0.74, P = 0.0002), but no significant difference was observed for suvorexant alone (OR = 0.40, 95% CI 0.11–1.53, P = 0.18). The current literature thus supports the effectiveness of suvorexant with or without ramelteon for delirium prevention, although suvorexant alone failed to significantly reduce the incidence of delirium when benzodiazepine was administered. The present study was limited by the significant heterogeneity among the included studies, and caution should be exercised when interpreting the results. This study was registered in the PROSPERO database (CRD4202017964).

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Suvorexant for Reduction of Delirium in Older Adults After Hospitalization

Hatta,

Kishi,

Wada

et al. 2024

JAMA Netw Open

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ImportanceDelirium is common among older hospitalized adults. In addition to presenting immediate management issues, delirium can increase the long-term risk of dementia, institutionalization, and mortality. Delirium is associated with disrupted sleep, and prior studies suggest that some specific sleep-promoting agents may reduce delirium.ObjectiveTo evaluate the orexin receptor antagonist suvorexant for reducing delirium in older adults at high risk for delirium after hospitalization.Design, Setting, and ParticipantsThis double-blind, placebo-controlled, phase 3 randomized clinical trial was conducted at 50 hospitals in Japan between October 22, 2020, and December 23, 2022. The study population included Japanese adults aged 65 to 90 years who were at high risk for delirium (mild cognitive impairment or mild dementia, history of delirium at prior hospitalization, or both) and had been hospitalized for acute disease or elective surgery. Data analysis was performed between January 23 and March 13, 2023.InterventionParticipants were randomized 1:1 to suvorexant (15 mg) or placebo taken at bedtime for up to 7 days while in the hospital.Main Outcomes and MeasuresDelirium, the primary end point, was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria while participants were hospitalized. The treatment difference in the proportion of participants with delirium was analyzed.ResultsThis study included 203 participants: 101 were treated with suvorexant (mean [SD] age, 81.5 [4.5]; years; 52 men [51.5%] and 49 women [48.5%]) and 102 received placebo (mean [SD] age, 82.0 [4.9] years; 45 men [44.1%] and 57 women [55.9%]). There were 17 participants with delirium (16.8%) in the suvorexant group compared with 27 (26.5%) in the placebo group (difference, −8.7% [95% CI, −20.1% to 2.6%]; P = .13). Adverse events were similar between the 2 groups.Conclusions and RelevanceIn this randomized clinical trial of suvorexant in older adults at high risk for delirium after hospitalization, fewer participants taking suvorexant had delirium compared with placebo, but the difference was not statistically significant. Further studies are needed to determine whether suvorexant may be useful for reducing delirium, particularly delirium with a hyperactive component, in this population.Trial RegistrationClinicalTrials.gov Identifier: NCT04571944

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Real-World Preventive Effects of Suvorexant in Intensive Care Delirium

Cited by 15 publications

References 0 publications

Relationship between preoperative anxiety and onset of delirium after cardiovascular surgery in elderly patients: focus on personality and coping process

Relationship between preoperative anxiety and onset of delirium after cardiovascular surgery in elderly patients: focus on personality and coping process

Suvorexant with or without ramelteon to prevent delirium: a systematic review and meta‐analysis

Suvorexant for Reduction of Delirium in Older Adults After Hospitalization

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