Switching to lemborexant for the management of insomnia in mental disorders (the SLIM study).

STUDY OBJECTIVES: We conducted a retrospective study to investigate the efficacy and safety of switching from other hypnotics, including benzodiazepines, Z-drugs (BZDs), suvorexant, ramelteon, mirtazapine, trazodone, and antipsychotics to lemborexant (LEB), a dual orexin receptor antagonist, for 3 months (3M).

METHODS: Clinical data obtained from the medical records of 61 patients treated at the Horikoshi Psychosomatic Clinic between December 2020 and February 2022 were analyzed, including the Athens Insomnia Scale (AIS), Epworth Sleepiness Scale (ESS), and Perceived Deficits Questionnaire-5 (PDQ-5). The primary outcome was the mean change in the AIS score after 3M. Secondary outcomes were the mean changes in the ESS and PDQ-5 scores over 3M. We also compared pre- and post-diazepam equivalents.

RESULTS: The mean AIS score decreased over 3M after switching to LEB (1M, -2.98 ± 5.19, P <0.001; 2M, -3.20 ± 5.64, P <0.001; 3M, -3.38 ± 5.61, P <0.001). Mean ESS score did not change from baseline to 1M (-0.49 ± 3.41, P -0.27), 2M (0.082 ± 4.62, P = 0.89), or 3M (-0.64 ± 4.80, P = 0.30). Mean PDQ-5 score did improve from baseline to 1M (-1.17 ± 2.47, P = 0.004), 2M (-1.05 ± 2.97, P = 0.029), and 3M (-1.24 ± 3.06, P = 0.013). There was also a reduction in the total diazepam equivalent (baseline, 14.0 ± 20.2 versus 3M, 11.3 ± 20.6, P <0.001).

CONCLUSIONS: Our study showed that, by switching to LEB from other hypnotics, the risks associated with BZDs may be reduced.