The Quest for the Best Dual Orexin Receptor Antagonist (Daridorexant) for the Treatment of Insomnia Disorders

ChemMedChem. 2020 Dec 3;15(23):2286-2305. doi: 10.1002/cmdc.202000453. Epub 2020 Oct 28.

Abstract

Since its discovery in 1998, the orexin system has been of interest to the research community as a potential therapeutic target for the treatment of sleep/wake disorders, stress and anxiety disorders, addiction or eating disorders. It consists of two G protein-coupled receptors, the orexin 1 and orexin 2 receptors, and two neuropeptides with agonistic effects, the orexin A and orexin B peptides. Herein we describe our efforts leading to the identification of a promising set of dual orexin receptor antagonists (DORAs) which subsequently went through physiology-based pharmacokinetic and pharmacodynamic modelling>[1] and finally led to the selection of daridorexant, currently in phase 3 clinical trials for the treatment of insomnia disorders.

Keywords: G protein-coupled receptors; drug design; insomnia; orexin receptor antagonists; structure-activity relationships.

MeSH terms

  • Dose-Response Relationship, Drug
  • Humans
  • Imidazoles / chemistry
  • Imidazoles / pharmacology*
  • Molecular Structure
  • Orexin Receptor Antagonists / chemistry
  • Orexin Receptor Antagonists / pharmacology*
  • Orexin Receptors / metabolism*
  • Pyrrolidines / chemistry
  • Pyrrolidines / pharmacology*
  • Sleep Initiation and Maintenance Disorders / drug therapy*
  • Sleep Initiation and Maintenance Disorders / metabolism

Substances

  • Imidazoles
  • Orexin Receptor Antagonists
  • Orexin Receptors
  • Pyrrolidines
  • daridorexant