Effects of Solriamfetol on Cognition in Patients with Excessive Daytime Sleepiness Associated with Narcolepsy in the Real-World SURWEY Study
Introduction: Patients with narcolepsy often exhibit neuropsychological deficits, particularly in alertness, attention, executive function, and decision-making. Solriamfetol (Sunosi®), a dopamine/norepinephrine reuptake inhibitor and TAAR1/5HT1a agonist, is approved to treat excessive daytime sleepiness (EDS) associated with narcolepsy or obstructive sleep apnea (OSA). Solriamfetol improved cognitive performance in patients with OSA and cognitive impairment. We report neuropsychological outcomes in patients with narcolepsy following solriamfetol treatment in a real-world setting.
Methods: Neuropsychological outcomes were assessed in adult patients with narcolepsy in a retrospective observational study (SURWEY) conducted in Germany using data from physicians prescribing solriamfetol for narcolepsy. Tests included the Test of Attentional Performance (TAP), Regensburger Word Fluency Test (RWT), Wechsler Memory Scale (WMS-IV), Wechsler Adult Intelligence Scale (WAIS-IV, subtest “coding“), and British Columbia Cognitive Complaints Inventory (BC-CCI). Data were collected prior to and 3 months after solriamfetol initiation.
Results: Before solriamfetol initiation, patients (Nf52) showed deficits in subjective cognition on the BC-CCI (mean±SD, 9.2±2.6), impaired alertness on the TAP (263.5±25.6 ms with warning signal and 265.5±26.0 ms without), and reduced psychomotor and visual speed on the WAIS-IV coding subtest (6.9±1.7); no impairments in word fluency or memory were observed. After 3 months of treatment, BC-CCI scores improved by 39.4%, alertness (TAP) increased by 10.5%, and the coding subtest improved by 34.3%. ESS scores improved by 3.9 points (95% CI, -4.4, -3.3); EDS reduction was not associated with cognitive improvement.
Conclusion: In this observational study, solriamfetol improved cognitive function in patients with narcolepsy-associated cognitive impairment, independent of changes in EDS.
