SynthesisTranslational psychiatry2025
Comparative efficacy and safety of daridorexant, lemborexant, and suvorexant for insomnia: a systematic review and network meta-analysis.
Synthesis in Translational psychiatry, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 6 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- Vornorexant versus lemborexant for insomnia disorder: a systematic review and network meta-analysis.The international journal of neuropsychopharmacology · 2026Pooled it
- Pooled it
- Glucagon-like peptide-1 receptor agonists for weight management in mental illness: a network meta-analysis.Translational psychiatry · 2026Pooled it
- Long-term use of dual orexin receptor antagonists for the treatment of insomnia: a systematic review and meta-analysis.Arquivos de neuro-psiquiatria · 2026Pooled it
- Comparative effects of hypnotic agents on sleep architecture and respiratory outcomes in obstructive sleep apnea: A systematic review and network meta-analysis.Psychiatry and clinical neurosciences · 2026Pooled it
- The "efficacy window" phenomenon of daridorexant in insomnia treatment: a dose-dependent time-course meta-analysis.Frontiers in pharmacology · 2026Pooled it
- Hypnotic doses of fazamorexant induced less impairment on balance and cognition than zolpidem in healthy younger and elderly individuals.British journal of clinical pharmacology · 2026Trial
- Recommendations on Switching or Deprescribing Hypnotic Medications for Insomnia.Deutsches Arzteblatt international · 2026Review
- Dual orexin receptor antagonist-assisted dose reduction of benzodiazepines and benzodiazepine receptor agonists: a mirror-image analysis of insurance claims data.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2026Article
- Comparison of objective sleep variables in schizophrenia with comorbid insomnia treated with dual orexin receptor antagonists versus benzodiazepine receptor agonists.PCN reports : psychiatry and clinical neurosciences · 2026Article
- Self-Reported Adverse Events in Psychiatric Outpatients Taking Hypnotics: Higher Real-World Frequencies Than Those Listed in Package Inserts.Neuropsychopharmacology reports · 2026Article
- Full-Dose Distribution and Age-Dose Concordance of Suvorexant: A Retrospective Drug Utilization Study at a Japanese University Hospital.Pharmacy (Basel, Switzerland) · 2026Article
- Research Progress and Future Perspectives of Orexin Receptor Antagonists in Insomnia Therapy.Molecules (Basel, Switzerland) · 2026Review
- Orexin receptor antagonists for major depressive disorder: perspectives from a systematic review and meta-analysis.Molecular psychiatry · 2026Article
- Insomnia disorder.Nature reviews. Disease primers · 2026Review
- Effects of daridorexant on sleep architecture in Japanese patients with insomnia disorder: analysis of a phase II randomized controlled trial.Sleep and biological rhythms · 2026Article
- Optimal use of dual orexin receptor antagonists for insomnia: a network meta-analysis perspective.Translational psychiatry · 2026Article
- Beyond traditional sleeping pills: safety, efficacy and multidisease potential of three approved orexin receptor antagonists.Frontiers in psychiatry · 2026Review
- Sleep disorders in stroke rehabilitation: mechanisms, impacts, and multidisciplinary management - a narrative review.Frontiers in neurology · 2026Review
- Pharmacological modulation of hyperarousal in insomnia associated with major depressive disorder: a narrative review of sedating antidepressants and orexin receptor antagonists.Frontiers in psychiatry · 2026Review
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn order to appraise the risk-benefit balance of the three available dual orexin receptor antagonists (DORAs; daridorexant, lemborexant, and suvorexant) for the management of adults with insomnia, we conducted a systematic review and random-effects model network meta-analysis.
methodsIncluded were all published double-blind, randomized, placebo-controlled trials of these agents. Outcomes included subjective time to sleep onset at month 1 (sTSO, primary), subjective total sleep time at month 1 (sTST, co-primary), subjective wake after sleep onset at month 1, Insomnia Severity Index scores at month 1, all-cause discontinuation, discontinuation due to adverse events, and the incidence of individual adverse events such as somnolence, dizziness, falls, headache, nasopharyngitis, and upper respiratory tract infection.
resultsThis meta-analysis included eight trials (5198 adults, average age = 56.33 years, 67.84% female). The treatment arms included daridorexant 25 mg/day (DAR25), daridorexant 50 mg/day (DAR50), lemborexant 5 mg/day (LEM5), lemborexant 10 mg/day (LEM10), suvorexant 20 mg/day (15 mg/day for people ≥65years, SUV20/15), and placebo. All active-treatments outperformed placebo in terms of all efficacy outcomes. The standardized mean difference (95% CI) in primary outcomes ranged from; sTSO: -0.430 (-0.568, -0.292) for LEM10 to -0.164 (-0.296, -0.031) for SUV20/15 and sTST: -0.475 (-0.593, -0.357) for DRA50 to -0.206 ( -0.330, -0.082) for LEM5. An additional sensitivity analysis suggested that DRA25, LEM10, and SUV20/15 were associated with a higher incidence of somnolence compared to a placebo.
conclusionsConsidering that there is no evidence that DORAs are associated with physiological tolerance, withdrawal symptoms, or rebound insomnia when abruptly discontinued, and that sleep architecture is not adversely affected, the DORAs appear to be a favorable choice in managing insomnia disorder in adults.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.