Nature and Science of Sleep (Sep 2023)
Individualized Treatment Patterns for Patients with Narcolepsy Treated with Oxybate: A Clinical Practice Perspective
Abstract
Asim Roy,1 Diane Ito,2 Susan Morris,3 Shawn Candler,4 Judi Profant,3 Charles Bae5 1Ohio Sleep Medicine Institute, Dublin, OH, USA; 2Stratevi LLC, Santa Monica, CA, USA; 3Jazz Pharmaceuticals, Palo Alto, CA, USA; 4Jazz Pharmaceuticals, Philadelphia, PA, USA; 5Penn Sleep Center, University of Pennsylvania, Philadelphia, PA, USACorrespondence: Asim Roy, Ohio Sleep Medicine Institute, 4975 Bradenton Avenue, Dublin, OH, 43017, USA, Tel +1 614-766-0773, Fax +1 614-766-2599, Email [email protected]: Real-world data regarding divided nightly dosing of oxybate and individualized prescribing in patients with narcolepsy are limited. Study objectives were to understand oxybate prescribing practices, including optimizing dose regimens and adjusting dosing per occasional changes in patients’ routines, and physician recommendations for representative patient scenarios.Patients and Methods: A cross-sectional, web- and audio-based survey of physicians treating ≥ 2 patients with narcolepsy, prescribed nightly oxybate (sodium oxybate) dosing for ≥ 6 months, was conducted. Physicians were surveyed on patients’ usual oxybate dosing regimens, frequency of and reasons for oxybate dosing-related discussions, and preferred methods for and perceptions of adjusting oxybate dosing. Physicians provided dosing-related guidance for 4 representative scenarios.Results: Participating physicians (N=25) were neurologists (52%), psychiatrists (44%), and neuropsychiatrists (4%). Individualized oxybate prescribing practices were reflected by the variability of physicians’ reporting of the percentage of their patients being prescribed once-nightly, twice-nightly, and thrice-nightly dosing regimens. Most physicians (68%) reported discussing adjusting individualized treatment to accommodate occasional changes to patients’ routines; the most common reasons were consuming contraindicated beverages (alcohol; 65%) and travel (59%). Adjusting total nightly dose (68%) and dose timing (68%) were preferred adjustment methods. Most physicians (88%) felt the ability to individualize oxybate dosing was important and had a positive impact on ability to provide care. For each representative scenario, physicians provided several dose-adjustment recommendations, and physician responses encouraged patient participation in treatment decision-making.Conclusion: Physicians provided guidance supportive of oxybate dose adjustments to accommodate occasional changes in patients’ routines, and perceived individualized dosing as important in providing care.Plain Language Summary: Why was the research needed?Narcolepsy is an uncommon condition that causes individuals to feel sleepy throughout the day. Other symptoms may include sudden muscle weakness. There is no cure for narcolepsy, but there are several treatments, including medicines known as oxybates. This study focused on how doctors use oxybate to treat patients with narcolepsy.How was the research done?This study was an online survey of doctors who were treating 2 or more patients with narcolepsy. Patients had been taking oxybate for at least 6 months. The survey asked doctors about their patients’ normal oxybate usage, how often and why they discussed oxybate treatment, and which ways oxybate treatment was usually adjusted.What are the results?Twenty-five doctors took part in this study. Most doctors said they discuss personalized treatment to help with occasional changes in their patients’ daily lives. The most common reasons for making treatment changes were consuming alcohol and travel. The most common changes were total nightly amount and timing of oxybate. Most doctors said the ability to personalize oxybate treatment is important and has a positive impact.What does the research mean?This study provides valuable knowledge on real-world oxybate treatment patterns and the conditions when doctors make clinical decisions about treating patients with narcolepsy.Graphical Abstract: Keywords: sodium oxybate, low-sodium oxybate, calcium, magnesium, potassium, sodium oxybates, prescribing patterns, personalized dosing
