Pharmacologic Therapies Effective for Excessive Daytime Sleepiness

Solriamfetol, armodafinil-modafinil, and pitolisant reduce daytime sleepiness, with solriamfetol likely superior
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WEDNESDAY, May 10, 2023 (HealthDay News) -- For patients with obstructive sleep apnea (OSA), solriamfetol, armodafinil-modafinil, and pitolisant reduce daytime sleepiness, with solriamfetol likely superior, according to a systematic review and meta-analysis published online May 9 in the Annals of Internal Medicine.

Tyler Pitre, M.D., from McMaster University in Hamilton, Ontario, Canada, and colleagues compared the effectiveness of drugs for excessive daytime sleepiness (EDS) in OSA in a network meta-analysis of 14 trials with 3,085 patients assigned to any pharmacologic intervention.

The researchers found that solriamfetol improves Epworth Sleepiness Scale (ESS) scores compared with placebo at four weeks (mean difference, −3.85; high certainty), while armodafinil-modafinil and pitolisant-H3-autoreceptor blockers probably improve ESS scores (mean differences, −2.25 and −2.78, respectively; both moderate certainty). Solriamfetol and armodafinil-modafinil improve the Maintenance of Wakefulness Test compared with placebo at four weeks (standardized mean differences, 0.9 and 0.41, respectively; both high certainty), while pitolisant-H3-autoreceptor blockers probably do not (moderate certainty). Armodafinil-modafinil probably increases the risk for discontinuation due to adverse events at four weeks (relative risk, 2.01; moderate certainty), while the association for solriamfetol was not found to be significant.

"Solriamfetol, armodafinil-modafinil, and pitolisant are effective therapies available to patients with OSA-associated EDS already on conventional therapy," the authors write. "Potential for long-term harm of all available pharmacotherapy remains unclear."

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