![]() This kind of preference information is becoming increasingly important in healthcare research in general, and it can help support the development of treatments, inform clinical guidelines, supplement health technology assessments, and contribute to regulatory decisions. Additionally, understanding patients’ treatment preferences may help physicians prescribe treatments that better address patients’ needs, with the aim of improving patient satisfaction, compliance and adherence. Given the complexity of the pharmacological insomnia treatment landscape, knowledge of patients’ treatment preferences, and especially the trade-offs they are willing to make between benefits and risks, can help support decision-making about specific pharmacological therapies. Understanding the relative importance that patients place on various treatment aspects, such as the degree of concern with withdrawal effects associated with benzodiazepines and Z-drugs, can help guide treatment selection. Based on the results of these two trials, daridorexant was recently approved in the United States and Europe for adults with insomnia who have difficulties with sleep onset or maintenance. The most common adverse effects, as with other dual orexin receptor antagonists, were headache, somnolence, and fatigue. The two trials showed improved sleep outcomes in adults with insomnia treated with daridorexant 25 mg and 50 mg and improved daytime functioning in those treated with daridorexant 50 mg. For example, daridorexant was tested in two large, phase III, multi-center, double-blinded, randomized, placebo-controlled studies conducted in adult and elderly patients with insomnia disorder. ![]() Dual orexin receptor antagonists, developed over the last two decades, have advanced the pharmacological management of insomnia because they improve sleep outcomes but do not appear to lead to dependence or tolerance, although they may cause somnolence or fatigue. Recently, a boxed warning was added to the US labeling for zolpidem, noting that its use is associated with complex sleep behaviors. However, they can also cause drowsiness, dizziness, cognitive impairment, dependence, and other adverse effects. For example, benzodiazepines and Z-drugs, such as zolpidem, can decrease sleep onset time, reduce wake time after sleep onset, and improve sleep duration and quality. Several medications with varying safety and efficacy are currently approved for the treatment of chronic insomnia. The results of this study allow for a patient-centric interpretation of clinical trial data. This supports using daytime functioning as an endpoint when evaluating the efficacy of insomnia treatments and carefully weighing the efficacy of a treatment in improving daytime functioning against its risks when making a treatment recommendation in medical practice. This study showed that patients’ preferences for insomnia medications are strongly driven by a desire to improve daytime functioning and avoid medication withdrawal effects. Little is known about the preferences of patients with insomnia for pharmacological treatments or the trade-offs between benefits and risks they are willing to make.
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