Efficacy and safety of daridorexant for the treatment of insomnia disorder in women of menopausal transition age: Insights from a randomized controlled trial

OBJECTIVES: To evaluate the efficacy and safety of daridorexant in women aged 47-55 years with insomnia disorder, an age group representative of the menopause transition. STUDY DESIGN: In this randomized, double-blind, placebo-controlled study (NCT03545191), conducted in 10 countries between May 2018 and May 2020, 930 patients with insomnia disorder were randomized using interactive response technology (1:1:1) to receive a single film-coated tablet of daridorexant 25 mg, 50 mg, or placebo every evening for 3 months. Subgroup analyses were performed among the 117 women aged 47-55 (25 mg n = 43; 50 mg n = 35; placebo n = 39). MAIN OUTCOME MEASURES: Efficacy endpoints included change from baseline to Month 3 of treatment in polysomnography-measured wake after sleep onset (WASO) and latency to persistent sleep (LPS), self-reported total sleep time (sTST), and insomnia-related daytime impairment, as recorded on the Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ). Safety endpoints included adverse events and score on a visual analog scale for morning sleepiness. Efficacy was analyzed in all randomized subjects, and safety in all who received at least one treatment dose. RESULTS: At Month 3, daridorexant 50 mg vs placebo decreased WASO and LPS by a least-squares mean (LSM) of 13.8 min (95 % CI -29.0, 1.4) and 14.7 min (-30.0, 0.6) respectively, increased sTST by an LSM of 21.8 min (-3.9, 47.4) and decreased (improved) IDSIQ total score by an LSM of 4.1 (-14.4, 6.3). No marked deviations from the effect in the overall population were observed. The incidence of somnolence/fatigue was low and comparable across groups. Morning sleepiness improved in all groups. CONCLUSIONS: These analyses suggest that daridorexant 50 mg provides benefit in sleep outcomes and daytime functioning in women aged 47-55 with insomnia disorder. Daridorexant 50 mg is well tolerated in this population, with no increased risk of next-morning sleepiness or somnolence. GOV IDENTIFIER: NCT03545191.