Narcolepsy and Idiopathic Hypersomnia Real-World Treatment Patterns and Changes in Alerting Agent Use After...

Various medications are prescribed to treat narcolepsy and idiopathic hypersomnia (IH), including low-sodium oxybate (LXB) and alerting agents (AAs; i.e., stimulants and wake-promoting agents). This study assessed treatment patterns in individuals with narcolepsy/IH, as well as changes in AA utilization following LXB initiation.

Optum^® Market Clarity data were used to examine individuals aged ≥ 7 years with narcolepsy and individuals aged ≥ 18 years with IH. Treatment patterns were assessed following index until the end of the study period (07/2007-09/2023) and in the post-LXB approval period (narcolepsy: 07/2020-09/2023; IH: 08/2021-09/2023). Changes in AA treatment in the 180 days following LXB initiation were evaluated. Data were analyzed descriptively.

The narcolepsy cohort included 43,252 individuals (mean [SD] age 42.8 [17.2] years; 62.9% female). In the total and post-LXB (n = 10,220) follow-up periods, 30.9% and 35.3%, respectively, did not receive any treatment of interest. The most frequent first-line treatments were AAs (total follow-up: 52.9%; 76.5% among those treated; post-LXB period: 49.3%; 76.1% among those treated). Among 788 individuals with AA treatment prior to LXB initiation, 42.9% experienced AA discontinuation or reduction following LXB initiation. The IH cohort included 24,528 individuals (mean [SD] age 45.8 [15.7] years; 61.7% female). In the total and post-LXB (n = 2971) follow-up periods, 54.1% and 50.3%, respectively, did not receive any treatment of interest. The most frequent first-line treatments were AAs (total follow-up: 31.2%; 67.9% among those treated; post-LXB period: 36.2%; 72.9% among those treated). Among 96 individuals with AA treatment prior to LXB initiation, 53.1% experienced AA discontinuation or reduction following LXB initiation.

Numerous treatment trajectories were observed after narcolepsy/IH diagnosis, highlighting the complexity in treating these conditions. Many individuals did not receive any treatment over the total follow-up period, which may indicate a treatment gap. AA discontinuation or reduction was common following LXB initiation.