Pilot Study of Lemborexant for Insomnia in Cancer Patients with Delirium

Abstract

Delirium occurs very frequently in cancer patients. Insomnia is a symptom of delirium. Lemborexant is a drug that regulates sleep–wake rhythms without causing extrapyramidal symptoms. Based on its ability to improve sleep, lemborexant is expected to have efficacy for insomnia with delirium. The purpose of this study was to determine the efficacy of lemborexant for insomnia in cancer patients with delirium. A retrospective observational study was conducted between July 2020 and February 2021. Fourteen patients (six females; mean age,69 years) were included. Lemborexant was effective in 11 of 14 (78.6%) patients. Of 14 patients, 10 had hyperactive delirium. Lemborexant might have similar efficacy for insomnia with and without delirium when compared with previous studies. The efficacy rate of lemborexant was 70% for patients with insomnia and hyperactive delirium. This study might lead to dose reductions of antipsychotic medications and fewer extrapyramidal symptoms in cancer patients with delirium.

Preventive Effects of Ramelteon, Suvorexant, and Lemborexant on Delirium in Hospitalized Patients With Physical Disease

“…Although previous meta-analyses showed that suvorexant was effective in preventing delirium, 35 the present cohort study is the first to include two orexin receptor antagonists (suvorexant and lemborexant) and a melatonergic agonist (ramelteon) and examine their association with delirium prevention. Moreover, while previous studies [26][27][28][29][30][31][32][33][34][36][37][38][39][40][41]43,44 on delirium were conducted in specific population groups at a high risk of delirium, such as older adults, ICU patients, and those in postoperative periods, this study included the general population; therefore, it may be valuable in that it reflects a wider range of cases observed in clinical practice. In this study, suvorexant and lemborexant were significantly associated with a lower risk of delirium in hospitalized patients under all conditions, whereas benzodiazepines significantly increased the occurrence of delirium.…”

“…A new orexin receptor antagonist, lemborexant, was approved by the US Food and Drug Administration in 2019 and was subsequently approved in Japan in 2020. A pilot study on patients with cancer 43 reported sleep improvement following lemborexant usage for delirium. A retrospective observational study 44 on emergency hospitalized patients reported that lemborexant may be effective in preventing delirium.…”

Evaluation of Suvorexant and Lemborexant for the Prevention of Delirium in Adult Critically Ill Patients at an Advanced Critical Care Center

“…26,27 Suvorexant has been reported to have a preventive effect against delirium. [23][24][25] Terada et al 28 reported that lemborexant is also effective in sleep disturbances in cancer patients with delirium. However, few articles have reported the You are prohibited from making this PDF publicly available.…”