Titration Common in Solriamfetol, Leads to Improvements in Daytime Sleepiness

According to the Solriamfetol real-world experience study (SURWEY) study done by Yaroslav Winter and colleagues (2023), Solriamfetol (Sunosi; Jazz Pharmaceuticals), an FDA-approved medication for excessive daytime sleepiness (EDS), is commonly initiated at a dosage of 75 mg/day, with titration being a common practice. Patients who received solriamfetol experienced improvements in their Epworth Sleepiness Scale (ESS) scores and most patients perceived an improvement in their EDS status. The most common starting doses were 75 mg/day (69%) or 150 mg/day (20%), with almost half of the patients having their treatment titrated. Titration was most commonly completed within 7 days. For patients who changed treatment, most of them (88%) were switched to solriamfetol abruptly.

Investigators collected retrospective chart reviews from 70 German adults with EDS and narcolepsy, and classified them into changeover (61%), add-on (27%), or new-to-therapy (11%) subgroups based on their existing EDS treatment. More than half of the patients had cataplexy and most were treated in sleep centers. The mean age of the cohort was 36.9 (±13.9) years, and the mean body mass index was 26.7 (standard deviation [SD]. 5.2) kg/m. Solriamfetol, a dopamine/norepinephrine reuptake inhibitor, was approved in the European Union in 2020 and the United States in 2019 to treat EDS associated with narcolepsy (75-150 mg/day) and obstructive sleep apnea (OSA; 37.5-150 mg/day).

The SURWEY study was initiated to collect real-world data describing physician dosing and titration strategies to optimize care for European patients. Eligible patients had achieved a stable dose of solriamfetol and completed at least 6 weeks of treatment. Prior to solriamfetol, the most commonly reported previous medications were modafinil (66%) and pitolisant (49%). From initiation to follow-up, the mean ESS score improved from 17.6 to 13.6, and ESS scores improved regardless of initiation strategy. Overall, 91% of patients reported slight or strong improvements in their EDS after initiating solriamfetol, with results similar across subgroups. From the physician perspective, most patients (94%) had slight or strong improvements in EDS.

At the end of the study, 72% of the cohort reported no change in their perceived nighttime sleep quality after solriamfetol initiation; however, some patients (19%) reported improvements. Throughout the study, 30% of the cohort experienced adverse events, with headache (9%), decreased appetite (6%), and insomnia (6%) being the most common.

References:

Meglio, M. (2023, February 22). Titration Common in Solriamfetol, Leads to Improvements in Daytime Sleepiness. Neurology Live. Retrieved February 23, 2023, from https://www.neurologylive.com/view/titration-common-solriamfetol-leads-improvements-in-daytime-sleepiness

Winter Y, Mayer G, Kotterba S. Solriamfetol real world experience study (SURWEY): initiation, titration, safety, effectiveness, and experience during follow-up for patients with narcolepsy from Germany. Sleep Med. 2023;103:138-143. doi:10.1016/j.sleep.2023.01.022.