FIRST-LINE TREATMENT PATTERNS IN PATIENTS WITH INSOMNIA: A LARGE-SCALE, REAL-WORLD COHORT STUDY

Abstract Introduction Current pharmacologic treatments for insomnia are not universally effective, are associated with a range of adverse events, can cause daytime impairment, and have the potential to be abused. With no consistent standard of care, many patients with insomnia experience multiple dose changes and medication switches. The current study leveraged large-scale, real-world data to investigate the pharmacological treatment patterns of patients with insomnia. Methods Exploratory analyses were performed on claims data from the HealthVerity US primary care claims database. Data from 10/2015 to 3/2020 were obtained for patients aged 18+. Prescribing patterns, including initial treatment, switching, concomitant treatment, and discontinuation were explored. Results Of approximately 1.4 million individuals, 265,382 (~19%) had an insomnia diagnosis and 42.4% of that group were prescribed hypnotic medications. Among those, first prescriptions were most frequently a Z-drug (zolpidem, eszopiclone, zaleplon; 35.8%), trazodone (25.0%), a benzodiazepine (15.6%), or another class (23.6%; includes orexin receptor antagonists, antidepressants, melatonin agonists, etc.). For those receiving a benzodiazepine first, median treatment duration was 55 days, 80.4% of subjects discontinued, 11.6% were switched to a different medication, and 7.9% received concomitant treatment with another sleep medicine. For those first receiving a Z-drug, median treatment duration was 81 days, 87.3% discontinued, 8.2% were switched, and 4.4% received concomitant treatment. For those receiving trazodone first, median treatment duration was 104 days, 85.8% of patients eventually discontinued, 5.8% of patients received concomitant treatment with an additional hypnotic agent, and 8.4% switched to a different hypnotic. Furthermore, of those switched from trazodone, 22% were switched to a benzodiazepine, 31% to a Z-drug, and 47% to a medication of another class. Conclusion These results demonstrate a lack of a standard first-line treatment approach for insomnia; it is likely that physicians have their own preferences, or that they might tailor treatment choice to individual patient characteristics. Additionally, more insomnia patients are discontinued from medical treatment than are switched to a different medicine. Further study is needed to determine what proportion of treatment discontinuation is due to successful treatment, versus being due to adverse events or lack of efficacy. Support (If Any) Idorsia Pharmaceuticals, Ltd.