Factors Associated with Prescriptions for an Orexin Receptor Antagonist Among Japanese Patients with Insomnia: Analysis of a Nationwide Japanese Claims Database

Shoki Okuda; Zaina P Qureshi; Yukiko Yanagida; Chie Ito; Yuji Homma; Shigeru Tokita

doi:10.1007/s40801-023-00356-4

Factors Associated with Prescriptions for an Orexin Receptor Antagonist Among Japanese Patients with Insomnia: Analysis of a Nationwide Japanese Claims Database

Drugs Real World Outcomes. 2023 Jun;10(2):271-281. doi: 10.1007/s40801-023-00356-4. Epub 2023 Mar 3.

Authors

Shoki Okuda¹, Zaina P Qureshi², Yukiko Yanagida³, Chie Ito⁴, Yuji Homma⁴, Shigeru Tokita³

Affiliations

¹ Medical Affairs, MSD K.K., Tokyo, Japan. shoki.okuda@merck.com.
² Center for Observational and Real-world Evidence (CORE), Merck & Co., Inc., Rahway, NJ, USA.
³ Medical Affairs, MSD K.K., Tokyo, Japan.
⁴ JMDC Inc., Tokyo, Japan.

Abstract

Background: Few studies have examined the prescribing patterns of orexin receptor antagonists (ORAs) in the real-world clinical setting in Japan.

Objective: We sought to analyze the factors associated with ORA prescriptions for patients with insomnia in Japan.

Methods: Outpatients (aged ≥ 20 to < 75 years old) prescribed one or more hypnotic for insomnia between April 1, 2018 and March 31, 2020 with continuous enrollment for ≥ 12 months were extracted from the JMDC Claims Database. We performed multivariable logistic regression to identify factors (patient demographics and psychiatric comorbidities) associated with ORA prescription in new or non-new users of hypnotics (patients without or with hypnotics prescription history, respectively).

Results: Of 58,907 new users, 11,589 (19.7%) were prescribed ORA at the index date. Male sex (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.12-1.22) and presence of bipolar disorders (OR 1.36, 95% CI 1.20-1.55) were associated with greater odds of ORA prescription. Among 88,611 non-new users, 15,504 (17.5%) were prescribed ORA at the index date. Younger age and several psychiatric comorbidities, such as neurocognitive disorders (OR 1.64, 95% CI 1.15-2.35), substance use disorders (OR 1.19, 95% CI 1.05-1.35), bipolar disorders (OR 1.14, 95% CI 1.07-1.22), schizophrenia spectrum disorders (OR 1.07, 95% CI 1.01-1.14), and anxiety disorders (OR 1.05, 95% CI 1.00-1.10), were associated with greater odds of ORA prescription.

Conclusion: This is the first study to determine the factors associated with ORA prescriptions in Japan. Our findings could help guide appropriate insomnia treatment using ORAs.