Daridorexant: exploring its role in the treatment of insomnia disorder

INTRODUCTION: Daridorexant is a dual orexin receptor antagonist with optimized pharmacokinetics to improve sleep and daytime functioning, without residual effects. This review summarizes the evidence for daridorexant in the management of insomnia disorder. AREAS COVERED: This article gives a brief overview of insomnia disorder and the mechanism of action for dual orexin receptor antagonists; it also gives coverage to the distinct pharmacokinetics of daridorexant. Evidence evaluating daridorexant in the management of insomnia disorder is summarized, based on a narrative literature search of PubMed and Embase. All full-length publications reporting original research of Phase 1-4 clinical trials and observational studies of daridorexant were considered. EXPERT OPINION: Consistent nightly treatment with daridorexant showed significant and clinically meaningful improvements in both sleep and daytime functioning at the 50 mg dose. In clinical trials, daridorexant demonstrated efficacy across objective and patient-reported sleep measures in a broad adult population, including older adults, and efficacy was maintained for up to 1 year. Reduced wakefulness throughout the entire night with daridorexant was associated with improvement in daytime functioning. Head-to-head comparisons with standard insomnia hypnotics are limited to a Phase 2 dose-finding study. Its favorable safety profile makes daridorexant appropriate for many patients, including older adults.