0602 Evaluating Pharmacotherapy Effectiveness in a Narcolepsy and Idiopathic Hypersomnia Retrospective Clinical Cohort. (12th April 2019)

• Record Type: Journal Article
• Authors: Pascoe, Maeve; Bena, James; Foldvary-Schaefer, Nancy
• Is Part Of: Sleep. Volume 42(2019)Supplement 1
• Page Start: A239
• Page End: A240
• Publication Date: 2019-04-12
• Subjects: Sleep -- Physiological aspects -- Periodicals; Sleep disorders -- Periodicals; Sommeil -- Aspect physiologique -- Périodiques; Sommeil, Troubles du -- Périodiques; Sleep disorders; Sleep -- Physiological aspects; Sleep -- physiological aspects; Sleep Wake Disorders; Psychophysiology; Electronic journals; Periodicals; 616.8498
• DOI: 10.1093/sleep/zsz067.600
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: Introduction: With new pharmacotherapeutic options for narcolepsy and idiopathic hypersomnia emerging, studies exploring outcomes in real world settings will be needed to inform optimal clinical care. We evaluated the association between daytime sleep propensity and treatment regimen/standardized dose, a measure of drug burden, in patients with narcolepsy type 1 (NT1)/type 2 (NT2) and idiopathic hypersomnia (IH). Methods: Patients ≥18yrs with NT1/NT2 and IH presenting to the Cleveland Clinic Sleep Disorders Center from 2008-2010 with completed Epworth Sleepiness Scales (ESS) at baseline and ≥6mo follow-up were included. A standardized variable of the amount of drug taken daily was determined using established World Health Organization methods. Standardized dose (STD)>1 indicated dose regimens higher than average for a single drug in adults. ESS change by treatment regimen (monotherapy vs polytherapy) and STD was assessed by t-tests and univariable/multivariable linear regressions, adjusting for patient characteristics. Results: 92 patients (26(28.3%) NT1, 27(29.3%) NT2, 39(42.4%) IH) were included (age 43.8±14.8yrs; 66(71.7%) female). At baseline, 59(64.1%) used monotherapy with average STD 1.0[0.0, 2.5] and ESS 14.2±5.2(68 patients>10). Between time points, polytherapy increased by 24(26.1%) patients, STD increased by 0.7[0.0, 1.3], and ESS decreased by 3.6±5.1(p<0.001; -25 patients>10). Those on polytherapy at follow-up had higher baseline ESS (2.4 greater, p=0.029) and were more likely to have NT1/NT2 (39.3% more likely, p<0.001) and be taking medication at baseline (25.0% more likely; p=0.012). ESS improved comparably between monotherapy and polytherapy groups (mean decrease 3.07 vs 4.47, both p<0.001), as well as between NT1/NT2 and IH (mean decrease 4.06 vs 2.95, both p<0.001). Only baseline ESS score was significant for predicting ESS change in univariable/multivariable analyses (showing 0.62pt decrease in ESS change per unit increase in baseline ESS). However, after adjusting for baseline ESS, baseline STD, and follow-up time, multivariable analyses showed that ESS change increased by 0.58pts for each 1 unit increase in STD at follow-up(p=0.056). Conclusion: While monotherapy/polytherapy analyses show no differences between groups in change in ESS, using a novel STD approach, our findings support a potential paradoxical relationship between drug burden and sleep propensity. Support (If Any)