Lemborexant safer than suvorexant for managing insomnia

GABA receptor agonists are used for managing insomnia, but these are tied to adverse events on long-term usage. The side effects include impairment in cognition, falls, abuse and dependence.

To address this concern, Dual orexin receptor antagonists (DORAs) were developed as an alternative and their action is not mediated by GABA receptors. According to a recent study, these appear promising in improving cognition.

There needs to be more data comparing the safety and efficacy of suvorexant and Lemborexant. Considering this background, researchers further investigated in a retrospective cohort study.

The concluded study points are as follows:

• Researchers obtained data from 108 patients newly treated with suvorexant or lemborexant.
• Clinical Global Impressions-Improvement (CGI-I) and Clinical Global Impressions (CGI) Scale were used.
• There was no difference between the CGI-I scores in the suvorexant (mean 3.05) and lemborexant groups (mean 3.38 )
• The side effects incidence with continued treatment was not different between the suvorexant (12.5%) and lemborexant group (2.9%).
• Patients who switched from suvorexant to Lemborexant had CGI-I scores ≤4.
• There were no side effects reported after switching to lemborexant.

Lemborexant causes side effects less frequently than suvorexant, at least in the early stages of treatment.

The study has several limitations one evaluator scored the CGIs, and used CGI-I scores instead of a sleep-specific index; scores were not assessed at the pre-and post-dose outpatient visits; the CGI-I and side effects were evaluated simultaneously from the medical records at the first post-administration-visit.

Further reading:

Comparative efficacy and safety of suvorexant and lemborexant for insomnia treatment. Teruaki Hayashi et al. First published: 21 March 2023 https://doi.org/10.1002/pcn5.85