Prevention of Delirium using Daridorexant in Older Patients at High Risk

Introduction: Background: Delirium is a common and serious neuropsychiatric syndrome characterized by acute disturbances in attention, awareness, and cognition. It frequently occurs in hospitalized patients, particularly in the elderly, postoperative individuals, and those in intensive care units (ICUs). While non-pharmacological strategies remain the cornerstone of delirium prevention, pharmacological interventions have been explored to reduce the incidence and severity of delirium in high-risk populations. Based on current evidence and guidelines, pharmacological prophylaxis should not be routinely used for delirium prevention. However, recent studies show, that preventive administration of orexin-antagonists seem to reduce the incidence of delirium in patients at risk. Methods : We restrospectively analyzed data from a prospective observational study referring to the preventively administered measures to reduce the incidence of delirium in older patients at high risk.Patients with preventive administration of Daridorexant were retrospectively compared to patients who received general measures exclusively. The study was approved by the Ethics commeetee of the Heinrich-Heine-University, Duesseldorf. Results : Out of 997 patients, 27 non delirious patients received Daridorexant as a preventive measure. These patients were comparted to randomly retrieved 98 non-delirious patients with a comparable risk of delirium and without preventive drug treatment. [ Fig. 1 ] shows personal and medical data of both groups. There were no significant differences between groups.[ Fig. 2 ] [ 3 ] shows the incidence of delirium in both groups (2) and the duration of delirium in patients who developed delirium (2).The incidence of delirium was significantly lower in patients who received Daridorexant as a preventive measure compared to patients without preventive drug administration. In addition, in patients who developed delirium despite preventive measures the duration of delirium was shorter in patients who received Daridorexant Discussion: Conclusion: Our preliminary data suggest that Daridorexant seems to be an effective measure to reduce the incidence of delirium in high risk patients. Prospective randomized trials are needed and warranted.