This study will be conducted to evaluate whether the approach of direct transitioning to lemborexant (LEM) is supported for insomnia patients who are unsatisfied with current medication. Transition from Following 4 regimens of interest will be investigated; Z-Drug monotherapy, suvorexant (SUV) monotherapy, SUV and benzodiazepine receptor agonists (BZRA) combination therapy, and ramelteon (RMT) and BZRA combination therapy. Patients with insomnia who have been treated with one of the regimens but do not have treatment satisfaction will be enrolled. As a comprehensive indicator of patient satisfaction including treatment efficacy and safety, the proportion of patients with successful transitioning will be evaluated at 2 weeks after transitioning; thus important initial response after transitioning will be evaluated as a primary endpoint. In addition, as a secondary purpose, the treatment continuation, efficacy and tolerability, and the treatment impression for insomnia (Patient Global Impression of Insomnia) for 14 weeks after transitioning will be assessed.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
97
1. Pretreatment phase: Continue pre-registration treatment (Z-drug monotherapy) without LEM. 2. First treatment phase: Administer LEM 5 mg/day as a substitute for Z-Drug. Increasing LEM dose to 10 mg/day is allowed. 3. Maintenance phase: Succeed the treatment from the first treatment phase. Changing LEM dose is allowed. Rescue administration of Z-drug or RMT is allowed under a defined condition.
1. Pretreatment phase: Continue pre-registration treatment (SUV monotherapy) without LEM. 2. First treatment phase: Administer LEM 5 mg/day as a substitute for SUV. Increasing to LEM dose to 10 mg/day is allowed. 3. Maintenance phase: Succeed the treatment of the first treatment phase. Changing LEM dose is allowed.
1. Pretreatment phase: Continue pre-registration treatment (SUV and BZRA combination therapy) without LEM. 2. First treatment phase: Administer LEM 5 mg/day as a substitute for SUV and continue BZRA. Increasing to LEM dose to 10 mg/day is allowed. 3. Maintenance phase: Succeed the treatment of the first treatment phase. Changing LEM dose is allowed. Decreasing dose or discontinuation of BZRA is allowed. Rescue administration of Z-drug or RMT is allowed under a defined condition.
1. Pretreatment phase: Continue pre-registration treatment (RMT and BZRA combination therapy) without LEM. 2. First treatment phase: Administer LEM 5 mg/day as a substitute for RMT and continue BZRA. Increasing to LEM dose to 10 mg/day is allowed. 3. Maintenance phase: Succeed the treatment of the first treatment phase. Changing LEM dose is allowed. Decreasing dose or discontinuation of BZRA is allowed. Rescue administration of Z-drug or RMT is allowed under a defined condition.
YOU ARIYOSHI Sleep Clinic
Kitakyushu, Fukuoka, Japan
Kurume University Hospital
Kurume, Fukuoka, Japan
Hirota Clinic
Kurume, Fukuoka, Japan
Kurume University Medical Center
Kurume, Fukuoka, Japan
Kotorii Isahaya Hospital
Isahaya, Nagasaki, Japan
Ohshima Hospital
Nakatsukuma, Saga-ken, Japan
Sleep Support Clinic
Shinagawa, Tokyo, Japan
Sleep & Stress Clinic
Shinagawa, Tokyo, Japan
Kuwamizu Hospital
Kumamoto, Japan
Proportion of patients with successful LEM treatment at the end of the first treatment phase to the patients who started the first treatment phase.
The primary endpoint is the proportion of patients with successful LEM treatment at the end of the first treatment phase to the patients who started the first treatment phase. Evaluation is performed for each treatment group. Successful LEM treatment at the end of the first treatment phase is primarily defined as follows; * Patients who wish to continue LEM treatment at the end of the first treatment phase and actually move on to the maintenance phase * Patients who wish to continue LEM treatment at the end of the first treatment phase but do not move to the maintenance phase with a reason not related to the efficacy or safety of LEM treatment (e.g., relocation, clinic transfer, or a burden of site visit expenses)
Time frame: 2 weeks
Proportion of patients who continued LEM treatment and those who continued LEM monotherapy at the end of the first treatment phase and the maintenance phase.
Time frame: 2 - 14 weeks
Proportion of patients with an itemized positive response on the PGI-I at baseline, the end of the first treatment phase, and the end of the maintenance phase.
Time frame: 2 - 14 weeks
Proportion of patients with increased LEM dosage at the end of the first treatment phase and at the end of the maintenance phase.
Time frame: 2 - 14 weeks
Occurrence of adverse events during the first treatment phase and the maintenance phase.
Time frame: 2 - 14 weeks
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