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Abstract Introduction Previous studies indicated that patients with narcolepsy often exhibit neuropsychological deficits. Cognitive domains related to alertness, attention, executive function, and decision-making are predominantly impaired. Solriamfetol (Sunosi®) is a dopamine/norepinephrine reuptake inhibitor and TAAR1 / 5HT1a agonist approved to treat excessive daytime sleepiness (EDS) associated with narcolepsy or obstructive sleep apnea (OSA). Solriamfetol has been shown to improve cognitive performance in a clinical study of OSA patients with cognitive impairment. Here we report neuropsychological outcomes of narcolepsy patients following treatment with solriamfetol in a real-world setting. Methods Neuropsychological outcomes were assessed in a subgroup of adult narcolepsy patients in a retrospective observational study (SURWEY), which collected data from physicians in Germany who prescribed solriamfetol for narcolepsy. The test of attentional performance (TAP, subtest “alertness“), Regensburger Word Fluency Test (RWT), Wechsler Memory Scale (WSM-IV, subtest “visual reproduction“), Wechsler Adult Intelligence Scale (WAIS-IV, subtest “coding“), and British Columbia Cognitive Complaints Inventory (BC-CCI) were conducted prior to and 3 months following solriamfetol initiation. Data were analyzed with analysis of variance (ANOVA) repeated measures. Unadjusted linear regression models were fit on change from baseline of each outcome. Adjusted models were fit to evaluate associations between cognitive and ESS changes from baseline. Results Prior to initiation of solriamfetol, patients (N=52) showed cognitive deficits in BC-CCI (9.1±5.6), impaired alertness in TAP (263.8±26.0 ms with warning signal and 265.5±26.0 ms without), and psychomotor and visual speed in the subset “coding“ of WAIS-IV (6.8±1.6). After 3 months of solriamfetol treatment, assessment outcomes were compared to baseline values and BC-CCI improved by 39.4% (5.6±2.9), alertness increased by 10.5% (TAP: 236.0±17.7 ms with warning signal and 237.6.5±17.7 ms without), and the coding subtest improved by 34.3% (9.2±1.8). No reductions in word fluency or memory were observed prior to or 3 months following solriamfetol initiation. The ESS scores improved by 3.8±2.1. Reduction in EDS was not associated with improvement in any cognitive domain. Conclusion Data from this observational study demonstrates that solriamfetol has potential to improve cognitive function in patients with narcolepsy-associated cognitive impairment. This improvement was independent from its effect on EDS. Support (if any) Axsome Therapeutics, Jazz Pharmaceuticals, Pharmanovia
Winter et al. (Sat,) studied this question.