According to a new systematic review and meta-analysis published in The Lancet, several pharmacologic interventions for insomnia disorder seemed to work better than others.

The study included 170 randomized clinical trials, with 47,950 participants divided into groups and randomly administered one of 36 licensed or nonlicensed drugs or a placebo. The analysis revealed that more recently developed drugs worked by targeting the orexin neurotransmitter system. Lemborexant seems to be the most successful orexin antagonist for short-term and long-term treatment. At the same time, Doxepin, Seltorexant, and Zaleplon were well tolerated but lacked some evidence for efficacy and other crucial outcomes. Eszopiclone was found to be linked with side effects such as nausea and vertigo.

Overall, it was found that a large number of approved medications were successful in treating insomnia acutely but had poor tolerability or insufficient information on long-term effects, while nonlicensed drugs like Melatonin, Ramelteon, and others failed to provide any overall material advantages.

The researchers concluded that further research targeting the pathway and orexin receptors was necessary to understand and help pave the way for better pharmacologic treatments for insomnia. (Medscape Medical News, Aug 09, 2022.)