Efficacy and safety of lemborexant as an alternative drug for patients with insomnia taking gamma‐aminobutyric acid–benzodiazepine receptor agonists or suvorexant

Background Although gamma‐aminobutyric acid–benzodiazepine (GABA‐BZ) receptor agonists are used to treat insomnia, their long‐term or high‐dosage use causes adverse events. Nevertheless, evidence regarding the discontinuation and replacement of GABA‐BZ receptor agonists with alternative agents is lacking. Suvorexant (SUX), an existing orexin receptor antagonist, is effective in preventing nocturnal awakening in 70%–75% of patients with insomnia. Methods The novel dual orexin receptor antagonist lemborexant (LEM) has fewer adverse effects than GABA‐BZ receptor agonists. Therefore, in this retrospective study, we categorised patients taking GABA‐BZ receptor agonists and SUX into LEM‐treated (switched) and non‐treated (non‐switched) groups and compared their outcomes over a 12‐week period. Results The GABA‐BZ group (N = 59) comprised 34 ‘switched’ and 25 ‘non‐switched’ and the SUX group (N = 14) comprised 6 ‘switched’ and 8 ‘non‐switched’ patients. A mixed model showed a significant diazepam equivalence reduction in patients taking GABA‐BZ receptor agonists and improved Athens Insomnia Scale score in those taking SUX. The safety and tolerability of GABA‐BZ receptor agonists and SUX were high, and no serious adverse effects were observed after switching to LEM. Conclusions Lemborexant may be a useful alternative for long‐term GABA‐BZ receptor agonist users. For SUX, the number of cases (N = 6) was insufficient to draw definite conclusions.