Masakazu Hatano

We conducted a retrospective study using medical records from Fujita Health University Hospital to evaluate the treatment discontinuation rates of suvorexant and lemborexant in patients with insomnia and to clarify differences in treatment acceptability. This study included patients newly prescribed suvorexant or lemborexant in the Department of Psychiatry between July 2020 and December 2022. The primary endpoint of the study was the discontinuation rate of suvorexant and lemborexant at 4 weeks. Discontinuation due to adverse events and lack of efficacy were assessed as secondary outcomes. The medical records of 1404 patients who were initiated on a dual orexin receptor antagonist during the study period were reviewed, and 1091 patients were included in the final analysis (suvorexant, 323; lemborexant, 768). We estimated the average treatment effect using the inverse probability of treatment weighting based on the propensity score. Discontinuation rates due to all-cause or adverse events did not differ significantly between the two drugs. However, the discontinuation rate due to lack of efficacy was significantly lower for lemborexant (4.9%; 38/768) compared to suvorexant (7.1%; 23/323), with an odds ratio of 0.63 (95% confidence interval, 0.48-0.83). This exploratory finding suggests a potential difference in treatment acceptability associated with efficacy between suvorexant and lemborexant in routine clinical practice, warranting further investigation.

AIM: This network meta-analysis of randomized controlled trials (RCTs) aimed to investigate which hypnotics are associated with the most favorable sleep architecture and respiratory outcomes in adults with obstructive sleep apnea. METHODS: Primary outcomes included total sleep time (TST) and apnea-hypopnea index (AHI) during TST. Other outcomes were rapid eye movement (REM) sleep time, latency to persistent sleep (LPS), wake after sleep onset (WASO), sleep efficiency (SE), AHI during non-REM or REM sleep, mean peripheral oxygen saturation (SpO2) during TST, mean SpO2 nadir during TST, arousal index (AI), all-cause discontinuation, adverse event-related discontinuation, and incidence of individual adverse events. Effect sizes with 95% confidence intervals were calculated. RESULTS: This systematic review included 32 RCTs (n = 1871, average age = 51.60 years, 62.52% male, mean AHI = 23.60). Our network meta-analysis evaluated brotizolam, daridorexant, eszopiclone, flurazepam, lemborexant, nitrazepam, ramelteon, temazepam, triazolam, zaleplon, zolpidem, zopiclone, and placebo. Compared with placebo, lemborexant increased TST, REM sleep time, and SE and decreased LPS and WASO, whereas both daridorexant and zolpidem increased TST and SE and decreased WASO. These three medications demonstrated respiratory safety and discontinuation profiles similar to those of placebo. Eszopiclone increased TST and SE and decreased LPS, WASO, AHI during TST, and AI, but its effects on LPS, WASO, AHI during TST, and AI disappeared in the sensitivity analysis, excluding continuous positive airway pressure titration studies. CONCLUSION: Our network meta-analysis identified different effects of various hypnotics on sleep architecture and respiratory parameters; however, the lack of data prevented a formal synthesis of subjective outcomes. Therefore, these results should be interpreted with caution in clinical practice.

BACKGROUND: Cognitive dysfunction has a significant impact on social functioning, such as employment, in patients with schizophrenia. However, existing cognitive assessments are time-consuming, impose a significant burden on patients, and require specialized training for evaluators, making them impractical for routine clinical use. Therefore, the present study investigated whether a simple and novel assessment tool, called Psychomotor Function Tests (PFT), correlates with existing Neuropsychological Tests (NT) and assessments with the Life Assessment Scale for the Mentally Ill (LASMI), which evaluates social functioning, including employment. METHODS: Cognitive function was examined in 24 patients with schizophrenia using NT (the Japanese Adult Reading Test, Trail Making Test (TMT), and word fluency test) and tablet-based PFT, while social functioning was evaluated using LASMI. Twenty-four healthy controls (HCs) underwent the same cognitive assessments. RESULTS: Psychomotor function, as evaluated by the choice reaction time, compensatory tracking test, and rapid visual information processing, was significantly worse in patients with schizophrenia than in HCs (p < 0.001). Furthermore, the composite score of PFT correlated with the time required for TMT (r = -0.707, -0.637) and LASMI subscales related to work, endurance & stability, self-recognition, required skills, and retention skills (r = -0.640, -0.689, -0.634, -0.420, -0.548). CONCLUSION: PFT correlated with existing NT, which are widely used in cognitive function assessments. Cognitive function examined by PFT was closely associated with social functioning. These results suggest the potential of PFT for evaluating cognitive function in routine clinical settings for patients with schizophrenia.

BACKGROUND: The optimal duration for maintaining antidepressant treatment in individuals with obsessive-compulsive disorder (OCD) who achieve symptom stabilization remains unclear. METHODS: This systematic review and pairwise meta-analysis of double-blind randomized placebo-controlled trials (DBRPCTs) compared antidepressant maintenance and antidepressant discontinuation groups in terms of relapse rate at each DBRPCT study endpoint (primary outcome), OCD symptom improvement, all-cause discontinuation, and adverse event-related discontinuation. Furthermore, relapse rates at 4, 8, 12, 16, 20, and 24 weeks were compared between the groups. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. The absolute risk reduction (ARR) and number needed to treat to benefit (NNTB) for relapse rates were also estimated. RESULTS: Nine trials (n = 1084; mean age: 32.8 years; proportion of males: 53.3%) were included. The antidepressant maintenance group had lower relapse rates at each DBRPCT study endpoint (RR [95% CI] = 0.53 [0.42-0.68]; ARR = 21.0%; NNTB = 5) and lower all-cause and adverse event-related discontinuation rates than the antidepressant discontinuation group. The maintenance group also exhibited lower relapse rates at 4 weeks (RR [95% CI] = 0.47 [0.31-0.70]; ARR: not significant; NNTB: not significant), 8 weeks (0.42 [0.31-0.57]; 12.0%; 8), 12 weeks (0.43 [0.32-0.56]; 18.0%; 6), 16 weeks (0.41 [0.32-0.52]; 25.0%; 4), 20 weeks (0.43 [0.34-0.53]; 26.0%; 4), and 24 weeks (0.42 [0.33-0.52]; 27.0%; 4) than the discontinuation group. Moreover, the maintenance group outperformed the discontinuation group regarding OCD symptom improvement. CONCLUSIONS: Individuals with OCD may benefit from continued antidepressant treatment, provided that it is well tolerated.