Solriamfetol for Excessive Daytime Sleepiness in Patients With Narcolepsy and OSA Reporting Anxiety and Depression in the Real-World SURWEY Study
Introduction: Psychiatric comorbidities are common in patients with excessive daytime sleepiness (EDS) from narcolepsy or obstructive sleep apnea (OSA). Solriamfetol (Sunosi®), a dopamine/norepinephrine reuptake inhibitor and TAAR1/5HT1a agonist approved for treating EDS in narcolepsy or OSA, has limited data in patients with severe psychiatric comorbidities. We describe the real-world use of solriamfetol in German patients with narcolepsy or OSA who self-reported depression/anxiety at baseline.
Methods: A retrospective chart review (SURWEY) was performed using data from German physicians prescribing solriamfetol to patients with EDS associated with narcolepsy or OSA, treated at a stable dose for ≥6 weeks. Comorbidities, including anxiety/depression, were documented at baseline; severe anxiety/depression were exclusionary.
Results: Of 154 patients, n=48 (31.2%) reported anxiety and/or depression (OSA, n=23/83 [27.7%], narcolepsy, n=25/71 [35.2%]). Baseline mean±SD Epworth Sleepiness Scale (ESS) scores were similar in patients (OSA, 16.1±2.8; narcolepsy, 17.9±3.6) and without (OSA, 16.0±3.3; narcolepsy, 17.5±2.9) anxiety/depression. Mean±SD ESS score decreases were 4.6±3.2 and 5.2±3.6 with and without anxiety/depression, respectively. Most patients (≥88%) and physicians (≥88%) reported improvement in EDS, which were similar across sleep etiologies and anxiety/depression presence. Common adverse events were headache, insomnia, and decreased appetite, occurring at similar rates regardless of anxiety/depression.
Conclusion: These real-world data describe solriamfetol treatment outcomes in patients with narcolepsy or OSA by self-reported anxiety/depression presence. Regardless of anxiety/depression, ESS scores improved, and most patients and physicians reported improved EDS. Our findings are consistent with clinical trial results and suggest solriamfetol is effective in managing EDS symptoms in this population regardless of common psychiatric comorbidities.
