Lemborexant vs suvorexant for insomnia: A systematic review and network meta-analysis

We conducted a random-effects model network meta-analysis to examine differences between lemborexant and suvorexant in efficacy and safety outcomes for treating patients with insomnia. We searched Embase, MEDLINE, and CENTRAL from their inception until April/28/2020. Primary outcomes were subjective time to sleep onset (sTSO), subjective total sleep time (sTST), and subjective wake-after-sleep onset (sWASO) at week 1. Four double-blind, randomized controlled trials were identified (n = 3237; 72.4% female; mean age 58.0 years). The treatment arm consisted of lemborexant 10 mg/d (LEM10, n = 592), lemborexant 5 mg/d (LEM5, n = 589), suvorexant 20/15 mg/d (SUV20/15, n = 493), zolpidem tartrate extended release 6.25 mg/d (ZOL6.25, n = 263), and placebo (n = 1300). All active treatments outperformed placebo regarding sTSO at week 1; standardized mean differences (95% credible interval): LEM10 = −0.51 (−0.63, −0.39), LEM5 = −0.48 (−0.60, −0.36), SUV20/15 = −0.21 (−0.33, −0.10), and ZOL6.25 = −0.30 (−0.46, −0.14); sTST at week 1: LEM10 = −0.58 (−0.70, −0.45), LEM5 = −0.33 (−0.46, −0.21), SUV20/15 = −0.34 (−0.46, −0.23), and ZOL6.25 = −0.42 (−0.59, −0.25); and sWASO at week 1: LEM10 = −0.42 (−0.57, −0.28), LEM5 = −0.26 (−0.40, −0.11), SUV20/15 = −0.18 (−0.32, −0.05), and ZOL6.25 = −0.37 (−0.56, −0.18). Although no significant differences were found in discontinuation due to adverse events between each active drug and placebo, LEM10 and SUV20/15 were associated with greater somnolence compared with placebo. LEM10 had the largest effect size compared with placebo for all primary outcomes, although with a risk of somnolence.