Suvorexant in the Prevention of Delirium in Elderly Hospitalized Patients
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Reviewed & Translated by Dat Tien Nguyen, B.A, ScM.
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Posted on October 14th, 2024
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Delirium presents a significant challenge in hospital care, particularly for older patients, where delirium episodes can lead to serious complications. Insomnia is a key factor that exacerbates delirium, suggesting that sleep-promoting treatments may help manage the condition. To explore this, a recent study, funded by Merck, evaluated the potential of suvorexant, an orexin receptor antagonist, to reduce the risk of delirium in hospitalized patients.
The phase 3 clinical trial involved 203 elderly participants, with an average age of 82, who had been hospitalized in Japan for either acute illnesses or surgeries requiring anesthesia. These patients were considered at high risk for delirium due to mild cognitive impairment or mild dementia. Participants were randomly assigned to receive either a placebo or 15 mg of suvorexant once daily. Delirium occurred in 16.8% of the suvorexant group and 26.5% of the placebo group, but the difference was not statistically significant. Further analysis revealed that suvorexant reduced the risk of hyperactive and mixed delirium by 10.7%. However, for hypoactive delirium, suvorexant was only effective in patients hospitalized for acute illnesses, not those recovering from surgery. The authors recommended that future studies increase the cohort size, factor the type and severity of acute diseases into analysis, and explore a higher dose of 20 mg, as approved by U.S. regulatory agencies.
The phase 3 clinical trial involved 203 elderly participants, with an average age of 82, who had been hospitalized in Japan for either acute illnesses or surgeries requiring anesthesia. These patients were considered at high risk for delirium due to mild cognitive impairment or mild dementia. Participants were randomly assigned to receive either a placebo or 15 mg of suvorexant once daily. Delirium occurred in 16.8% of the suvorexant group and 26.5% of the placebo group, but the difference was not statistically significant. Further analysis revealed that suvorexant reduced the risk of hyperactive and mixed delirium by 10.7%. However, for hypoactive delirium, suvorexant was only effective in patients hospitalized for acute illnesses, not those recovering from surgery. The authors recommended that future studies increase the cohort size, factor the type and severity of acute diseases into analysis, and explore a higher dose of 20 mg, as approved by U.S. regulatory agencies.