Higher discontinuation with dual orexin receptor antagonists than with benzodiazepines: A Japanese claims cohort...

This study aimed to evaluate the likelihood of discontinuing dual orexin receptor antagonists in patients continuously prescribed hypnotics using a large-scale claims database in Japan.

The cohort comprised 4422 patients identified from insurance claims data, who were newly prescribed a single hypnotic with more than three consecutive prescriptions over 3 months. The outcome was defined as the absence of a hypnotic prescription for 90 consecutive days after the final prescription. Kaplan-Meier and Cox proportional hazards analyses were used to compare the hazards of discontinuing hypnotics among four classes: benzodiazepines, non-benzodiazepines, dual orexin receptor antagonists, and melatonin receptor agonists, adjusting for age, sex, and the number of diagnostic categories based on the International Statistical Classification of Diseases, Tenth Revision.

Kaplan-Meier analysis revealed significant differences among the hypnotic classes (P < 0.001), with dual orexin receptor antagonists demonstrating the highest rate of discontinuation. Multivariable Cox regression indicated a significantly higher likelihood of discontinuing dual orexin receptor antagonists than that of benzodiazepines (hazard ratio = 1.40; P < 0.001). Older age (hazard ratio = 0.995; P < 0.001) and a higher number of International Statistical Classification of Diseases, Tenth Revision diagnostic categories (hazard ratio = 0.975; P < 0.001) were significantly associated with a lower likelihood of discontinuation.

Dual orexin receptor antagonists are more likely to be discontinued than benzodiazepines after continuous hypnotic prescription, highlighting their potential clinical utility in insomnia treatment.