Understanding the unmet needs in insomnia treatment: a systematic literature review of real-world evidence

Abstract

Study objective

The objective of this study was to define and characterize the unmet needs in the pharmacological management of insomnia.

Methods

A systematic literature review was conducted to identify relevant literature reporting real-world evidence in insomnia, published from January 2009 to April 2020. Pharmacological treatments – both prescription (benzodiazepines, ‘Z-drugs’ and suvorexant) and off-label (antidepressants, antipsychotics, and antihistamines) – were considered.

Results

Overall, 108 publications describing the humanistic (n = 59) and economic burden (n = 20) of insomnia, off-label treatment patterns (n = 28) and factors influencing treatment adherence or persistence (n = 8) were identified. A high prevalence of comorbid conditions was reported in patients with insomnia resulting in significantly lower health-related QoL compared to those with insomnia or a comorbidity alone. Current treatment options were associated with adverse events, including reduced sleep quality and next-day somnolence. An increased risk of accidents/injuries was also associated with insomnia and its treatment. Furthermore, safety concerns and perceived lack of efficacy for approved treatments have led to frequent off-label prescribing, despite a lack of clinical evidence of risk/benefit ratios. Safety concerns associated with benzodiazepines include risk of dependence, leading to prolonged treatment persistence and exacerbated adverse events, making them unsuitable for use in patients with chronic insomnia. Finally, the substantial economic burden of insomnia was evident, with reduced work productivity demonstrated in patients with insomnia compared to the general population.

Conclusions

This review highlights a clear unmet need for insomnia therapies that improve sleep quality without resulting in next-day impairment and/or dependence.

Keywords:

• Insomnia burden
• treatment patterns
• unmet needs
• real-world evidence

Acknowledgments

There are no acknowledgements to be made.

Disclosure statement

This work was funded by Eisai Inc., and Eisai was involved with all stages of the study conduct and analysis.

Funding

Eisai Inc. was the funding source and was involved with all stages of the systematic literature review.

Data availability statement

No new data were generated or analyzed in support of this research.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.