Daridorexant: Daridorexant is a dual orexin receptor antagonist (DORA) supplied as 50 mg film-coated tablets for oral administration. Participants receive 50 mg once nightly, 30 minutes before bedtime, for up to 9 weeks. Dose reduction to 25 mg is permitted based on tolerability. The drug is provided by Jiangsu Simcere Pharmaceutical Co., Ltd.
Study summary
Brief Summary:
This study is a prospective, multicenter, open-label cohort study designed to evaluate the efficacy and safety of transitioning adult patients with insomnia from benzodiazepine receptor agonists (BZRAs) to daridorexant.
A total of 156 participants will be enrolled. The study consists of a 1-week baseline phase and a 9-week daridorexant treatment phase. During the treatment phase, daridorexant 50 mg is initiated once daily while BZRAs are gradually tapered and discontinued based on individual patient response.
The primary outcome is the proportion of patients who successfully transition from BZRAs to daridorexant at Week 5, defined as a ≥50% reduction or complete discontinuation of the original BZRA dose, with continued willingness to take daridorexant and no withdrawal due to worsening insomnia or adverse events. Secondary outcomes include changes in Insomnia Severity Index (ISI) scores and patient-reported sleep outcomes.
This study aims to provide real-world evidence for the safe and effective transition from BZRAs to daridorexant in clinical practice.
Eligibility
Sex
ALL
Min age
18 Years
Max age
70 Years
Healthy volunteers
No
Inclusion Criteria:
1. Male or female, aged ≥18 and ≤70 years.
2. Meet DSM-5 diagnostic criteria for insomnia disorder: dissatisfaction with nighttime sleep despite adequate sleep opportunity, manifested as difficulty initiating sleep, difficulty maintaining sleep (frequent awakenings or difficulty returning to sleep after awakening), or early-morning awakening with inability to resume sleep, accompanied by subjective experience of daytime dysfunction. Symptoms occur ≥3 times per week and persist for ≥3 months.
3. Received stable BZRA monotherapy for at least 3 nights per week during the 1 month prior to enrollment.
4. Bedtime duration of no less than 7 hours per night.
5. Unsatisfactory response or intolerance to current therapy, with clinical need to adjust insomnia medication regimen.
6. Hamilton Anxiety Rating Scale (HAMA-14) score \<14.
7. Hamilton Depression Rating Scale (HAMD-17) score \<17.
8. Willing and able to comply with the study protocol and provide written informed consent.
Exclusion Criteria:
1. History of chronic insomnia \>5 years.
2. Other sleep disorders such as narcolepsy-related symptoms, restless legs syndrome, circadian rhythm sleep disorder, REM sleep behavior disorder, etc.
3. Daytime napping ≥1 hour/day and ≥3 days/week.
4. Daily BZRA dose exceeding the maximum recommended dose for insomnia treatment per package insert.
5. BZRA use \>5 nights per week.
6. History of BZRA treatment ≥3 years.
7. Concurrent use of two or more BZRAs within the past 3 months.
8. Use of central nervous system depressants within the past 3 months.
9. Use of long-acting sedative-hypnotics (e.g., clonazepam) within the past 3 months.
10. Use of anxiolytics or antidepressants for off-label insomnia treatment within the past 3 months.
11. Initiation of cognitive behavioral therapy for insomnia (CBT-I) within 1 month prior to Visit 1.
12. Prior non-response to orexin receptor antagonists (daridorexant, lemborexant, suvorexant, etc.).
13. Clinically significant disease (e.g., cardiac, respiratory, gastrointestinal, renal) that may affect participant safety or interfere with study assessments, as judged by the investigator. Participants for whom sedative medications are contraindicated due to occupational or safety reasons are also excluded.
14. Severe psychiatric disorder within the past 6 months, or severe alcohol/substance abuse/dependence within the past 2 years.
15. Active suicidal ideation or behavior within the past 6 months.
16. Pregnancy, lactation, or planned pregnancy within 90 days.
17. Unable to avoid excessive alcohol consumption during the study.
18. History of hypersensitivity to any component of daridorexant tablets.
19. Severe hepatic impairment (Child-Pugh score ≥10).
20. Unable to discontinue strong CYP3A4 inhibitors and strong or moderate CYP3A4 inducers during the study.
Primary outcome measure(s)
Proportion of Participants Successfully Transitioning from BZRAs to Daridorexant at Week 5 — At Week 5 (Visit 5, Day 42 ± 3 days) Defined as a ≥50% reduction or complete discontinuation of the original BZRA dose, with continued willingness to take daridorexant, and no withdrawal due to worsening insomnia or adverse events at Week 5 (Visit 5, Day 42 ± 3 days).
This page summarises publicly available registry data for informational purposes — not medical advice. Eligibility is determined by each study team; patients should discuss participation with their clinician.
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